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1.
Archivos españoles de urología ; 73(5):463-470, 2020.
Article in Spanish | IBECS | ID: covidwho-1016698

ABSTRACT

OBJETIVO: La pandemia provocada por el nuevo coronavirus SARS-CoV-2 ha tenido una elevada repercusión sobre la cirugía mínimamente invasiva (CMI). Ha surgido una importante controversia sobre la realización de CMI durante la pandemia COVID-19. Es prioritario, establecer un consenso sobre la organización y realización con seguridad de la CMI durante la pandemia. MATERIAL Y MÉTODOS: Se realizó una búsqueda web y en PubMed con los términos: "SARS-CoV-2", "COVID19", "COVID19 Urology", "COVID19 Surgery", "COVID19 transmission", "SARS-CoV-2 transmission", "COVID19 and minimally invasive surgery", "SARSCoV-2 and CO2 insuflation". Se realizó una revisión narrativa de la literatura y una síntesis de la evidencia disponible. Se ha utilizado una técnica de grupo nominal modificada, circulando un primer borrador a todos los autores y aprobándose la versión definitiva el día 26 de Mayo de 2020. RESULTADOS: No existe evidencia sobre una mayor exposición a SARS-CoV-2 en CMI respecto a cirugía abierta. La CMI se asocia a una menor estancia hospitalaria por lo que cambiar, sin justificación, la indicaciónde CMI puede retrotraer recursos que podrían ser utilizados para la pandemia COVID-19. Se debe priorizar la CMI según los recursos disponibles y la intensidad de la pandemia en cada momento. Se recomienda realizar despistaje de SARS-CoV-2 mediante cuestionario clínico-epidemiológico y PCR nasofaríngea 72 horas antes de la CMI electiva, para minimizar las complicaciones postoperatorias, evitar la transmisión cruzada entre pacientes y la posible exposición de los profesionales sanitarios. Se recomienda establecer medidas de organización en quirófano, de protección personal, técnica quirúrgica y manejo del CO2 y aerosoles generados para reducir la exposición y riesgos del personal sanitario. CONCLUSIONES: La CMI realizada con las medidasd e seguridad adecuadas para el paciente y profesionales, puede contribuir durante la desescalada a una menor utilización de recursos sanitarios y por tanto, no debe limitarse su utilización o cambiar sus indicaciones OBJECTIVE: SARS-CoV-2 pandemic has high repercussion on urologic minimally invasive surgery (MIS). Controversy about safety of MIS procedures during COVID-19 pandemic has been published. Nowadays, our priority should be create agreement in order to restart and organize MIS with safety conditions for patients and healthcare workers. METHODS: Pubmed and web search was conducted with following terms: "SARS-CoV-2", "COVID19";"COVID19 Urology", COVID19 Surgery", "COVID19 transmission", "SARS-CoV-2 transmission", "COVID19 and minimally invasive surgery""SARS-CoV-2 and CO2 insuflation". A narrative review of available literature and scientific evidence summary was done. A modify nominal group technique was used to achieve an expert consensus. First draft was circulated amongst authors. Definitive document was approved in May 26th. RESULTS: Non evidence supports higher risk of SARSCoV-2 healthcare workers infection with MIS compared to open surgery. MIS is associated with shorter hospital stay than open surgery. Modify MIS indications to open surgery, with no scientific evidence, could spend valuable resources in detriment to COVID-19 patients. MIS indications should be prioritized attending to available resources and pandemic intensity. SARS-CoV-2 screening 72 hours prior to surgery by clinical and epidemiological questionnaire and nasopharyngeal PCR is recommended, in order to prevent nosocomial transmission, professional infections and to minimize postoperative complications. Intraoperative steps should be established to reduce professional exposure to surgical aerosols, including: surgical room reorganization, adequate personal protective equipment, surgical technique optimization and management of CO2 and surgical smoke

2.
Int J Urol ; 28(1): 62-67, 2021 01.
Article in English | MEDLINE | ID: covidwho-868176

ABSTRACT

OBJECTIVE: To evaluate the coronavirus disease 2019 perioperative infection rate and mortality rate of patients undergoing urological surgeries during the early pandemic period in Spain. METHODS: This was a non-interventional multicenter prospective study carried out from 9 March to 3 May 2020 in two urology departments in Madrid, Spain. Clinical, microbiological and radiological data of patients who underwent surgery were collected from computerized medical records. RESULTS: A total of 148 patients were included in the study, and 141 were analyzed for nosocomial infection risk, after excluding previous and concomitant severe acute respiratory syndrome coronavirus type 2 infections. Elective surgeries represented 76.6% of the procedures, whereas emergent surgeries represented 23.4%. Preoperative screening was carried out with polymerase chain reaction test in 34 patients, all were negative. A total of 14 patients also had chest X-ray (not suspicious in all cases). Three patients (2.1%) developed severe acute respiratory syndrome coronavirus type 2 nosocomial infection (symptoms developed between the third day after surgery to the 14th day after hospital discharge). Time from admission to a compatible clinical case was 5.5 days (4-12 days). Two patients underwent surgery with concomitant diagnosis of coronavirus disease. The mortality rate due to severe acute respiratory syndrome coronavirus type 2 infection is 0.7%, and the specific mortality rate in patients undergoing surgery with community-acquired coronavirus disease 2019 infection was 50% (1/2). CONCLUSIONS: The nosocomial severe acute respiratory syndrome coronavirus type 2 infection rate was low in patients undergoing urological surgical procedures during the peak of the pandemic in Madrid. With appropriate perioperative screening, urological surgical activity can be carried out in safety conditions.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Urologic Surgical Procedures , Adult , Aged , COVID-19/mortality , Cross Infection/mortality , Female , Humans , Male , Middle Aged , Prospective Studies , Spain/epidemiology , Urology Department, Hospital
3.
Archivos espanoles de urologia ; 73(5):463-470, 2020.
Article | WHO COVID | ID: covidwho-601045

ABSTRACT

OBJECTIVE: SARS-CoV-2 pandemic hashigh repercussion on urologic minimally invasive surgery (MIS). Controversy about safety of MIS procedures during COVID-19 pandemic has been published. Nowadays, our priority should be create agreement in order to restart and organize MIS with safety conditions for patients and healthcare workers.METHODS: Pubmed and web search was conducted with following terms: "SARS-CoV-2", "COVID19", "COVID19 Urology", COVID19 Surgery", "COVID19 transmission", "SARS-CoV-2 transmission", "COVID19 nd minimally invasive surgery", "SARS-CoV-2 and CO 2insuflation". A narrative review of available literature and scientific evidence summary was done. A modify nominal group technique was used to achieve an expert consensus. First draft was circulated amongst authors. Definitive document was approved in May 26th.RESULTS: Non evidence supports higher risk of SARSCoV-2 healthcare workers infection with MIS compared to open surgery. MIS is associated with shorter hospital stay than open surgery. Modify MIS indications to open surgery, with no scientific evidence, could spend valuable resources in detriment to COVID-19 patients. MIS indications should be prioritized attending to available resources and pandemic intensity. SARS-CoV-2screening 72 hours prior to surgery by clinical and epidemiological questionnaire and nasopharyngeal PCRis recommended, in order to prevent nosocomial transmission, professional infections and to minimize postoperative complications. Intraoperative steps should be established to reduce professional exposure to surgical aerosols, including: surgical room reorganization, adequate personal protective equipment, surgical technique optimization and management of CO2 and surgical smoke. CONCLUSIONS: In COVID-19 pandemic de-escalation, MIS carried out with optimal safety measurements, could contribute to reduce hospital resources utilization. With current evidence, MIS should not be limited or reconverted to open surgery during COVID-19 pandemic. OBJETIVO: La pandemia provocada por el nuevo coronavirus SARS-CoV-2 ha tenido una elevada repercusion sobre la cirugia minimamente invasiva (CMI). Ha surgido una importante controversia sobre la realizacion de CMI durante la pandemia COVID-19. Es prioritario, establecer un consenso sobre la organizacion y realizacion con seguridad de la CMI durante la pandemia.MATERIAL Y METODOS: Se realizo una busqueda web y en PubMed con los terminos: SARS-CoV-2, COVID19,COVID19 Urology, COVID19 Surgery, COVID19 transmission, SARS-CoV-2 transmission, COVID19 and minimally invasive surgery, SARSCoV-2 and CO2 insuflation. Se realizo una revision narrativa de la literatura y una sintesis de la evidencia disponible. Se ha utilizado una tecnica de grupo nominal modificada, circulando un primer borrador a todos los autores y aprobandose la version definitiva el dia 26 de Mayo de 2020.RESULTADOS: No existe evidencia sobre una mayor exposicion a SARS-CoV-2 en CMI respecto a cirugia abierta. La CMI se asocia a una menor estancia hospitalaria por lo que cambiar, sin justificacion, la indicacionde CMI puede retrotraer recursos que podrian ser utilizados para la pandemia COVID-19. Se debepriorizar la CMI segun los recursos disponibles y la intensidad de la pandemia en cada momento. Se recomienda realizar despistaje de SARS-CoV-2 mediante cuestionario clinico-epidemiologico y PCR nasofaringea 72 horas antes de la CMI electiva, para minimizar las complicaciones postoperatorias, evitar la transmisioncruzada entre pacientes y la posible exposicion de los profesionales sanitarios. Se recomienda establecer medidas de organizacion en quirofano, de proteccion personal, tecnica quirurgica y manejo del CO2 y aerosoles generados para reducir la exposicion y riesgos del personal sanitario.CONCLUSIONES: La CMI realizada con las medidasd e seguridad adecuadas para el paciente y profesionales, puede contribuir durante la desescalada a una menor utilizacion de recursos sanitarios y por tanto, no debe limitarse su utilizacion o cambiar sus indicaciones.

4.
Eur Urol Focus ; 6(5): 1049-1057, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-597672

ABSTRACT

CONTEXT: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. OBJECTIVE: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). EVIDENCE ACQUISITION: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. EVIDENCE SYNTHESIS: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era. CONCLUSIONS: Functional, benign, and pelvic floor conditions have often been considered suitable for delay in challenging times. The long-term implications of this reduction in functional urology clinical activity are currently unknown. This document will help functional urology departments to reorganize their activity to best serve their patients. PATIENT SUMMARY: Many patients will suffer delays in urology treatment because of COVID-19, with consequent impairment of their physical and psychological health and deterioration of their quality of life. Efforts should be made to minimize the burden for this patient group, without endangering patients and health care workers.


Subject(s)
Coronavirus Infections/prevention & control , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Telemedicine , Urologic Diseases/diagnosis , Urologic Diseases/therapy , Urology/methods , Ambulatory Care , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cystitis, Interstitial/diagnosis , Cystitis, Interstitial/therapy , Disease Management , Female , Humans , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/therapy , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2 , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Urinary Retention/diagnosis , Urinary Retention/therapy , Urinary Tract Infections/diagnosis , Urinary Tract Infections/therapy , Urologic Surgical Procedures , Vesicovaginal Fistula/diagnosis , Vesicovaginal Fistula/therapy
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