A complete year of urology residency training under COVID-19: impact on education and health

ABSTRACT Objectives: To evaluate the impact of COVID-19 pandemics on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents after 1 year of socio-economic restrictions. Materials and Methods: An electronic survey was e-mailed to all postgraduate (PG) students registered by the Brazilian Society of Urology. The survey included an assessment of socio-demographic, clinical practice, educational, health-related and behavior parameters. We also evaluated which subareas of urology were predominantly affected. A similar survey was adapted and sent to the directors of all urology residency programs. Results: COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. Urology residents reported >50% decrease in multiple surgical modalities. We highlight kidney transplantation surgeries (66.2%), minor surgeries (62.3%), endoscopic surgeries (42.6%) and reconstructive surgeries (38.8%). This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. Furthermore, PG students faced stressful situations that caused worsening of mental and physical health, such as getting redirected to assistance of COVID-19 patients (66.9%), and high rate of infection by SARS-CoV-2 (58.2%). Conclusions: The COVID-19 pandemic has severely impacted the clinical, surgical, and educational activities of urology residents in Brazil. This could represent a critical skills gap that residents may face beyond the COVID-19 pandemic. PG students faced stressful situations that caused worsening of mental and physical health such as redirection to assistance of COVID-19 patients, concern about their own contamination and of family members.

Impact of COVID-19 on education, health and lifestyle behaviour of Brazilian urology residents

ABSTRACT Objectives: To evaluate the impact of COVID-19 on clinical and surgical practice, educational activities, health and lifestyle behavior of Brazilian urology residents. Materials and Methods: A web-based survey was sent to 468 Brazilian urology residents from postgraduate years (PGY) 3 to 5 to collect data on clinical practice and training after 4 months of COVID-19. We also assessed health-related and behavior changes, rate of infection by SARS-CoV-2, deployment to the front line of COVID-19, residents' concerns, and access to personal protective equipment (PPE). Results: Massive reductions in elective and emergency patient consultations, diagnostic procedures and surgeries were reported across the country, affecting PGY 3 to 5 alike. Most in-person educational activities were abolished. The median damage to the urological training expected for 2020 was 6.0 [3.4 - 7.7], on a scale from 0 to 10, with senior residents estimating a greater damage (P< 0.001). Educational interventions developed included online case-based discussions, subspeciality conferences and lectures, and grand rounds. Most senior residents favored extending residency to compensate for training loss and most younger residents favored no additional training (p< 0.001). Modifications in health and lifestyle included weight gain (43.8%), reduced physical activity (68.6%), increased alcoholic intake (44.9%) and cigarette consumption (53.6%), worsening of sexual life (25.2%) and feelings of sadness or depression (48,2%). Almost half were summoned to work on the COVID-19 front-line and 24.4% had COVID-19. Most residents had inadequate training to deal with COVID-19 patients and most reported a shortage of PPE. Residents' concerns included the risk of contaminating family members, being away from residency program, developing severe COVID-19 and overloading colleagues. Conclusions: COVID-19 had a massive impact in Brazilian urology residents´ training, health and lifestyle behavior, which may reflect what happened in other medical specialties. Studies should confirm these findings to help developing strategies to mitigate residents' losses.

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

ABSTRACT Objectives To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.

Antibioticoterapia profilática e auto-cateterismo intermitente limpo em pacientes com bexiga neurogênica por traumatismo raqui-medular / Prophylactic antibiotics and clean intermittent self-catheterization in patients with neurogenic bladder due to spinal cord injury

Introduçäo: O cateterismo intermitente revolucionou o tratamento de pacientes com bexiga neurogênica. Foi realizado um estudo sobre a profilaxia da infecçäo urinária em pacientes com bexiga neurogênica que realizavam cateterismo intermitente. Material e Métodos: 141 pacientes portadores de bexiga neurogênica hiperreflexa por lesäo medular traumática, realizando auto-cateterismo intermitente limpo, foram acompanhados durante o período de 1 ano, com o objetivo de observar a incidência de infecçäo urinária sintomática, sem (durante os primeiros 6 meses) e com (durante os 6 meses consecutivos) o emprego de antibiótico-profilaxia em baixas doses (AP) e desta forma estabelecer critérios para o tratamento de infecçäo urinária neste tipo de doente. Resultados: Durante o período em que foram mantidos sem AP, 90,1 porcento dos pacientes apresentaram urinocultura positiva, com a presença de sintomas em 90,1 porcento dos casos. Após o início da AP, 90,1 porcento dos pacientes apresentaram urinoculturas positivas, porém destes apenas 59 (46,45 porcento) apresentaram sintomas, necessitando de antibioticoterapia em dose plena. Sessenta e oito pacientes permaneceram assintomáticos (53,55 porcento), mesmo com urinocultura positiva. Conclusäo: Pacientes com cateterismo intermitente devido a bexiga neurogênica por traumatismo raqui-medular, quando mantidos em AP apresentaram incidência diminuída de infecçöes urinárias sintomáticas

Hipomagnesiúria e litíase renal / Hypomagnesemia and renal lithiasis

Dentre os 309 pacientes avaliados no Ambulatório de Litíase Renal do Hupe, segundo o protocolo de Pak, de 1987 a 1989, 91 foram selecionados aleatoriamente e submetidos a dosagem de magnésio urinário. Em 68 (74,7 por cento) casos encontramos magnesiúria normal. Em 23 casos (25,2 por cento) encontramos hipomagnesiúria (< 4mEq/24h), sendo que em dois (2,1 por cento) havia associaçao com hipercalciúria, em nove (9,8 por cento) associaçao com hiperuricosúria e em quatro (4,3 por cento) associaçao com hipercalciúria e hiperuricosúria. Em oito pacientes (8,7 por cento) a hipomagnesiúria foi achado único. Estes dados salientam a importância de se avaliar a magnesiúria em portadores de cálculo renal.

Reservatório urinário continente: uma alternativa para a substituiçäo vesical / Contigent urinary reservoir: an alternative for vesical substitution

Um segmento de íleo e de cólon é utilizado para criar uma neobexiga, após cistectomia com uma anastomose ceco-uretal. Esta técnica cirúrgica denominada Mainz Pouch utiliza 15 cm de ceco e cólon ascendente e duas alças ileais do mesmo comprimento para a construçäo de um reservatório urinário. Esta neobexiga permite a continência urinária, um grande reservatório de baixa pressäo, o esvaziamento vesical voluntário e o reimplante uretral com técnica anti-refluxo. Quatro pacientes foram submetidos a este procedimento após a cistoprostatectomia, poupando-se, porém, a inervaçäo responsável pela ereçäo. O seguimento destes pacientes variou entre oito e 14 meses. Os quatro pacientes estäo continentes, durante os períodos diurno e noturno. Três esvaziam suas neobexigas espontaneamente, em intervalos normais. Um paciente tem ereçöes e relaçöes sexuais.

O ácido úrico e a litíase renal / Uric acid and nephrolithiasis

Foram observados 197 pacientes portadores de cálculo renal, divididos em 2 grupos: 1§ Grupo: pacientes de cálculos näo urícos; e 2§ Grupo: pacientes com cálculos de ácido úrico. Todos, exceto um, pertencente ao segundo grupo, foram avaliados metabolicamente. No 1§ grupo, 50 dos 172 pacientes foram portadores de hiperuricosúria associada a hipercalcalciúria em 14 casos. No 2§ grupo, 24 dos 25 pacientes foram avaliados metabolicamente. Foi encontrada liríase idiopática em 2 pacientes, hiperuricosúria sem hiperuricemia em 12 casos e hiperuricosúria com hiperuricemia em 10 casos

Bexiga de choque / Bladder injury

O tratamento urológico dos pacientes vítimas de traumatismo raquimedular nem sempre é bem conduzido. Esquece-se que as complicaçöes urinárias säo as de maior morbidade nesse grupo de doentes. O presente artigo salienta a importância da abordagem urológica precoce, apresentando as diretrizes básicas apra o atendimento urológico desses pacientes ainda na fase aguda, de choque medular

Transplante renal / Renal transplantation

É relatada a experiência com 179 transplantes renais realizados no Hospital Universitário Pedro Ernesto. Säo descritos os protocolos comuns de seleçäo de doador, a técnica habitualmente empregada e as complicaçöes vasculares e urológicas

Reduplicaçäo ureteral em Y invertido / Inverted y ureteral reduplication

Apresenta-se um caso de reduplicaçäo ureteral em Y invertido, associado a ureterocele a cálculo. Faz-se revisäo da literatura e da embriologia ureteral, a fim de apresentar as teorias que explicam essa malformaçäo e outras anomalias associadas. Trata-se do segundo caso de reduplicaçäo ureteral em Y invertido associado a ureterocele na literatura

Estudo duplo-cego comparativo entre acetaminofen, dipirona e placebo na dor pós-operatória em urologia / Double-blind comparative study between acetaminophen, dipyrone and placebo in postoperative pain in urology

Este foi um estudo duplo-cego, controlado, de eficácia analgésica e tolerância ao emprego de dose única de acetaminofen (500mg), dipirona (500mg) e placebo, em 90 pacientes com dor pós-operatória em urologia. A eficácia dos tratamentos foi julgada pela análise dos escores de intensidade da dor, alívio da dor e necessidade de analgésico suplementar. A avaliaçäo dos parâmetros considerados revelou que o acetaminofen e a dipirona säo equipotentes como analgésicos, ambos se mostrando estatisticamente superiores ao placebo. Ambas as drogas foram bem toleradas. O modelo de dor pós-operatória em urologia se mostrou útil para o estudo de analgésicos