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1.
Infection ; 2021 Oct 30.
Article in English | MEDLINE | ID: covidwho-1491465

ABSTRACT

PURPOSE: To investigate the expression of the receptor protein ACE-2 alongside the urinary tract, urinary shedding and urinary stability of SARS-CoV-2 RNA. METHODS: Immunohistochemical staining was performed on tissue from urological surgery of 10 patients. Further, patients treated for coronavirus disease (COVID-19) at specialized care-units of a university hospital were assessed for detection of SARS-CoV-2 RNA in urinary samples via PCR, disease severity (WHO score), inflammatory response of patients. Finally, the stability of SARS-CoV-2 RNA in urine was analyzed. RESULTS: High ACE-2 expression (3/3) was observed in the tubules of the kidney and prostate glands, moderate expression in urothelial cells of the bladder (0-2/3) and no expression in kidney glomeruli, muscularis of the bladder and stroma of the prostate (0/3). SARS-CoV-2 RNA was detected in 5/199 urine samples from 64 patients. Viral RNA was detected in the first urinary sample of sequential samples. Viral RNA load from other specimen as nasopharyngeal swabs (NPS) or endotracheal aspirates revealed higher levels than from urine. Detection of SARS-CoV-2 RNA in urine was not associated with impaired WHO score (median 5, range 3-8 vs median 4, range 1-8, p = 0.314), peak white blood cell count (median 24.1 × 1000/ml, range 5.19-48.1 versus median 11.9 × 1000/ml, range 2.9-60.3, p = 0.307), peak CRP (median 20.7 mg/dl, 4.2-40.2 versus median 11.9 mg/dl, range 0.1-51.9, p = 0.316) or peak IL-6 levels (median: 1442 ng/ml, range 26.7-3918 versus median 140 ng/ml, range 3.0-11,041, p = 0.099). SARS-CoV-2 RNA was stable under different storage conditions and after freeze-thaw cycles. CONCLUSIONS: SARS-CoV-2 RNA in the urine of COVID-19 patients occurs infrequently. The viral RNA load and dynamics of SARS-CoV-2 RNA shedding suggest no relevant route of transmission through the urinary tract.

2.
Sex Med ; 9(4): 100380, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1309226

ABSTRACT

INTRODUCTION: The COVID-19 pandemic drastically altered the way of life around the world. Due to social distancing measures, contact restrictions and fears of infection, social life has changed significantly. These measures along with the stressors associated with the current worldwide situation, will inevitably have an effect on people's interpersonal and personal behaviors. AIM: This study evaluates the effect the COVID-19 pandemic and nationwide German lockdown had on the sexual behavior of cis men. METHODS: An anonymous nationwide web-based questionnaire was conducted among cis men in Germany during the first COVID-19 home isolation (April 20, 2020-July 20, 2020). The questionnaire was distributed via e-mail, online chats and social-media platforms. MAIN OUTCOME MEASURES: Data was collected on general characteristics including demographics and socio-economic backgrounds. To evaluate sexual health, questions from the Sexual Behavior Questionnaire were included. RESULTS: 523 cis male participated. 414 met the inclusion criteria. Most were heterosexual (n = 248, 59.9%; vs homosexual n = 97, 23.4%; vs bisexual n = 69, 16.7%). 243 (59%) were employed, 153 (37.1%) were students and 16 (3.9%) were unemployed. Most of the participants reported an annual income lower than 75.000€. During the lockdown, average weekly frequency of sexual intercourse and masturbation was increased in all groups. Consistently, a significant rise of higher satisfaction with the frequency of sexual contacts during the quarantine was observed (P < .05). Furthermore, the level of sexual arousal increased significantly in all groups (P < .0005). Capability to enjoy sexual intercourse or masturbation increased significantly in heterosexual (P < .0005) and homosexual men (P < .005). Bisexual participants showed a significant increase in general satisfaction with sexual life (P < .05) and a significant decrease in satisfaction in relationship or single life (P < .05). Positive confounders in the changing of sexual behavior during the COVID-19 pandemic were: Being in a relationship or being single, parenthood and being employed. CONCLUSION: Our study firstly describes how COVID-19 pandemic related restrictions and social distancing measurements altered sexual behavior amongst cis male in Germany. Further studies, including sexual minorities specifically, are needed to clarify if the behavior in the first German nationwide quarantine has persisted or transformed as the pandemic proceeded. Mumm J-N, Vilsmaier T, Schuetz JM, et al. How the COVID-19 Pandemic Affects Sexual Behavior of Hetero-, Homo-, and Bisexual Males in Germany. Sex Med 2021;9:100380.

3.
Urol Int ; 105(7-8): 650-656, 2021.
Article in English | MEDLINE | ID: covidwho-1216840

ABSTRACT

BACKGROUND: There are limited data on the use and concern of telemedicine among German urologists, and thus, there are no established guidelines for telemedical diagnosis, treatment, and prevention of urological indications. METHODS: An anonymized survey was conducted among German private practice urologists during the 2019 coronavirus disease (COVID-19) pandemic. The χ2 test, Mann-Whitney U-test, and Kruskal-Wallis test were used for statistical analysis. RESULTS: 257 urologists were included in the final analysis. Thirty-five (14.0%) of urologists had used telemedicine as part of their consultation, and 221 (86.0%) had not used telemedicine. There was no difference between telemedicine adoption rates between rural and urban settings. Telemedicine users were significantly more satisfied with the information they had received regarding telemedicine issues. Users saw the greatest barrier to telemedicine that patients do not take up the offer of telemedicine. Nonusers were most concerned with unclear indications for telemedicine followed by lesser reimbursements during telemedicine than in-person visitations. Users were significantly more likely to use telemedicine beyond the COVID-19 pandemic. Urologists, who wanted to use the service in the future, wanted an active support by the German society of urology and guidelines for telemedicine. Last, users and nonusers preferred telemedicine for non-acute chronic diseases and follow-up visitations. CONCLUSION: Despite the COVID-19 pandemic, telemedicine remains a rarely used service among German private practice urologists. Ultimately, to overcome the current challenges, urologists require an active support for the service through the German Society of Urology and telemedical guidelines.


Subject(s)
COVID-19 , Practice Patterns, Physicians'/trends , Private Practice/trends , Telemedicine/trends , Urologic Diseases/therapy , Urologists/trends , Urology/trends , Adult , Aged , Attitude of Health Personnel , Attitude to Computers , Germany , Health Care Surveys , Health Knowledge, Attitudes, Practice , Humans , Middle Aged , Urologic Diseases/diagnosis
4.
Urol Int ; 105(3-4): 192-198, 2021.
Article in English | MEDLINE | ID: covidwho-1066973

ABSTRACT

PURPOSE: To assess anxiety, stress level, and perception of safety during the coronavirus disease 2019 (COVID-19) pandemic in health care workers (HCWs) of one of Germany's largest urology university clinics. METHODS: A cross-sectional study among urological HCWs was performed. HCWs were surveyed for anxiety about the pandemic, stress level and current workload, fear of coronavirus infection, current perception of safety at work, and attitude towards protective equipment and tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). RESULTS: Sixty-three HCWs filled in the questionnaire. Overall anxiety of infection with CO-VID-19 is at a median of 4.7 with no statistically significant difference between nurses and physicians (p = 0.0749). Safety at work reaches a median of 6 out of 10. In fact, the highest fear in 56.7% (31/63) of the personnel is to get infected by a colleague tested positive for SARS-CoV-2 despite wearing surgical face masks. A proportion of 55.7 and 74.6% highly favor swabs for SARS-CoV-2 on a regular basis in HCWs and patients, respectively (p = 0.0001). Workload in the urology department is clearly reduced during the pandemic (physicians 39.3% vs. nurses 32.2%, p = 0.0001) and 57.4% do not feel distress at all; only 27.9% express mental distress. CONCLUSION: During the pandemic, urology HCWs perceive lower burden by workload and deem themselves at low risk of infection. However, the greatest anxiety is related to infection by a SARS-CoV-2-positive colleague, despite reciprocal protection by surgical face masks. This highlights a relevant mental stress and uncertainty towards management of infected HCWs, calling for increased education and psychological support.


Subject(s)
Anxiety/etiology , COVID-19/epidemiology , Health Personnel/psychology , Pandemics , Urology , Anxiety/epidemiology , Anxiety/psychology , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Male , SARS-CoV-2 , Surveys and Questionnaires
5.
World J Urol ; 39(7): 2559-2565, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-888173

ABSTRACT

PURPOSE: To ascertain renal cell carcinoma (RCC) financial toxicity on COVID-19 during the COVID-19 crisis as patients are struggling with therapeutic and financial implications. METHODS: An online survey was conducted from March 22 to March 25, 2020. It included baseline demographic, clinicopathologic, treatment-related information, anxiety levels related to COVID-19, questions related to financial concerns about COVID-19 as well as the validated 11-item COST measure. RESULTS: Five-hundred-and-thirty-nine patients (39%:58% male:female) from 14 countries responded. 23% of the patients did not feel in control of their financial situation but 8% reported being very satisfied with their finances. The median COST score was 21.5 (range 1-44). Metastatic patients who have not started systemic therapy had a COST score (19.8 range 2-41) versus patients on oral systemic therapy had a COST score (23.9 range 4-44). Patients in follow-up after surgery had a median COST score at 20.8 (range 1-40). A low COST scores correlated (p < 0.001) were female gender (r = 0.108), younger age (r = 0.210), urban living situation (r = 0.68), a lower educational level (r = 0.155), lower income (r = 0.165), higher anxiety about acquiring COVID-19 (r = 0.198), having metastatic disease (r = 0.073) and a higher distress score about cancer progression (r = 0.224). CONCLUSION: Our data highlight severe financial impact of COVID-19. Acknowledging financial hardship and thorough counseling of cancer patients should be part of the conversation during the pandemic. Treatment and surveillance of RCC patients might have to be adjusted to contemplate financial and medical needs.


Subject(s)
COVID-19 , Carcinoma, Renal Cell , Cost of Illness , Financial Stress/epidemiology , Kidney Neoplasms , Quality of Life , Antineoplastic Agents/economics , Antineoplastic Agents/therapeutic use , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Carcinoma, Renal Cell/economics , Carcinoma, Renal Cell/epidemiology , Carcinoma, Renal Cell/pathology , Carcinoma, Renal Cell/therapy , Female , Humans , Kidney Neoplasms/economics , Kidney Neoplasms/epidemiology , Kidney Neoplasms/pathology , Kidney Neoplasms/therapy , Male , Middle Aged , Neoplasm Staging , Psycho-Oncology , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology
6.
Eur Urol Focus ; 7(6): 1355-1362, 2021 11.
Article in English | MEDLINE | ID: covidwho-753592

ABSTRACT

BACKGROUND: While providers are challenged with treatment decisions during the coronavirus disease 2019 (COVID-19) crisis, decision making ultimately falls in the hands of patients-at present, their perspective is poorly understood. OBJECTIVE: To ascertain renal cell carcinoma (RCC) patients' perspectives on COVID-19 and understand the associated implications for treatment. DESIGN, SETTING, AND PARTICIPANTS: An online survey of RCC patients was conducted from March 22 to March 25, 2020, disseminated through social media and patient networking platforms. The survey comprised 45 items, including baseline demographic, clinicopathologic, and treatment-related information. Patients were additionally queried regarding their anxiety level related to COVID-19 and associated implications for their cancer diagnosis. INTERVENTION: An online survey study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics with graphical outputs were used to characterize survey results. RESULTS AND LIMITATIONS: A total of 539 patients (male:female 39%:58%) from 14 countries responded. Of them, 71% felt that their risk of COVID-19 infection was higher than the general population, and 27% contacted their physician to establish this. Among patients with localized disease (40%), most (42%) had scheduled surveillance scans within 6 wk-65% were unwilling to delay scans. Among patients with metastatic disease, 76% were receiving active therapy. While most patients preferred not to defer therapy (51%), patients receiving immune therapy regimens were less amenable to deferring therapy than those receiving targeted treatment (20% vs 47%). CONCLUSIONS: Despite high levels of anxiety surrounding COVID-19, many patients with RCC were inclined to adhere to existing schedules of surveillance (localized disease) and systemic treatment (metastatic disease). PATIENT SUMMARY: The coronavirus disease 2019 (COVID-19) pandemic has prompted many doctors to develop different treatment strategies for cancer and other chronic conditions. Given the importance of the patient voice in these strategies, we conducted a survey of patients with kidney cancer to determine their treatment preferences. Our survey highlighted that most patients prefer to continue their current strategies of kidney cancer treatment and monitoring.


Subject(s)
Anxiety/psychology , COVID-19/psychology , Carcinoma, Renal Cell , Kidney Neoplasms , Adult , Aged , COVID-19/epidemiology , Female , Health Care Surveys , Humans , Male , Middle Aged , Pandemics , Population Surveillance , Qualitative Research , Quality of Life/psychology , SARS-CoV-2
7.
Eur Urol Focus ; 6(5): 1097-1103, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-592041

ABSTRACT

BACKGROUND: Telehealth services are rapidly embraced in uro-oncology due to the current coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVE: To determine patients' perspective on adoption of telehealth as a response to the pandemic and its sustainability in the future. DESIGN, SETTING, AND PARTICIPANTS: Following a COVID-19 outbreak, 101 patients with advanced genitourinary cancers are currently managed "virtually" for therapy administration at our tertiary care unit. They were surveyed about the current situation, and current and long-term employment of telehealth. INTERVENTION: Rapid implementation of virtual patient management. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Patients' perception of anxiety of COVID-19 and cancer, perspective on telehealth measures as a reaction to the current COVID-19 pandemic, and long-term acceptance were used as outcomes. Wilcoxon matched-pair signed rank test, chi-square test, and Mann-Whitney U test were performed. RESULTS AND LIMITATIONS: Of 101 patients, 92 answered the questionnaire, with 71 (77.2%) responding virtually by e-mail or phone call. Anxiety of cancer (6/10, interquartile range [IQR] 3-8) superseded that of COVID-19 (four/10, IQR 2-5.25, p<0.001), and patients oppose temporary treatment interruption. Of the patients, 66.0% perceive their susceptibility to COVID-19 as equal to or lower than the general population and 52.2% believe that COVID-19 will not affect their therapy. In future, patients (62.6%) prefer to maintain in-person appointments as opposed to complete remote care, but accept remote care during the pandemic (eight/10, IQR 5-9). Beyond the crisis, maintaining telehealth has low preference rates (four/10, IQR 2-7), with high acceptance for external laboratory controls (60.9%) and online visit management (48.9%), but lower acceptance for remote treatment planning including staging discussions (44.6%) and for referral to secondary care oncologists (17.4%). CONCLUSIONS: Despite the pandemic, cancer remains the key concern and patients are not willing to compromise on their treatment. Rapid implementation of telehealth is tolerated well during the need of social distancing, with a clear "red line" concerning changes in existing patient-physician relationships. Balancing future implementation of telehealth while considering patients' demand for personal relationships will ensure human dignity in uro-oncology. PATIENT SUMMARY: We queried patients with genitourinary cancers treated in an almost virtual setting following a local coronavirus outbreak. Acceptance of telehealth during the current situation is high; however, long-term implementation of the adapted services is less favored. We deduce that patient-physician relationship is crucial for cancer patients and needs to be balanced against measures for social distancing to forge the future management.


Subject(s)
Attitude to Health , Coronavirus Infections/epidemiology , Patient Acceptance of Health Care , Patient Preference , Pneumonia, Viral/epidemiology , Telemedicine , Urogenital Neoplasms/therapy , Urology , Adult , Aged , Aged, 80 and over , Anxiety , Betacoronavirus , COVID-19 , Female , Humans , Kidney Neoplasms/therapy , Male , Medical Oncology , Middle Aged , Pandemics , Physician-Patient Relations , Program Evaluation , Prostatic Neoplasms/therapy , SARS-CoV-2 , Time-to-Treatment , Urinary Bladder Neoplasms/therapy
8.
Eur Urol ; 78(4): 624-628, 2020 10.
Article in English | MEDLINE | ID: covidwho-306004

ABSTRACT

The current coronavirus disease 2019 (COVID-19) pandemic is a challenge for physicians in triaging patients in emergency rooms. We found a potentially dangerous overlap of classical urinary symptoms and the as yet not fully described symptoms of COVID-19. After a patient was primarily triaged as a urosepsis case and then subsequently diagnosed with COVID-19, we focused on an increase in urinary frequency as a symptom of COVID-19 and identified this in seven males out of 57 patients currently being treated in our COVID-19 wards. In the absence of any other causes, urinary frequency may be secondary to viral cystitis due to underlying COVID-19 disease. We propose consideration of urinary frequency as an anamnestic tool in patients with infective symptoms to increase awareness among urologists during the current COVID-19 pandemic to prevent fatal implications of misinterpreting urological symptoms.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Cystitis/virology , Pneumonia, Viral/virology , Urinary Incontinence, Urge/virology , Urinary Tract Infections/virology , Urination , Urodynamics , Aged , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Cystitis/diagnosis , Cystitis/physiopathology , Host-Pathogen Interactions , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Prospective Studies , Retrospective Studies , Risk Factors , SARS-CoV-2 , Time Factors , Urinary Incontinence, Urge/diagnosis , Urinary Incontinence, Urge/physiopathology , Urinary Tract Infections/diagnosis , Urinary Tract Infections/physiopathology
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