Comparative evaluation using PRO of an algorithm of one-stage immediate alloplastic breast reconstruction versus two-stage reconstruction.

BACKGROUND: One-stage direct-to-implant (DTI) immediate breast reconstruction has proven to be an oncologically safe technique, but there are some conditions that do not allow its performance. The introduction of new surgical techniques and the recent COVID-19 pandemic have pushed us to introduce a breast reconstruction algorithm in our clinical practice. This allows a one-stage immediate reconstruction for all patients, regardless of their anatomical characteristics, the type of implants used, and the need for postoperative radiotherapy. METHODS: A total of 40 patients were recruited and divided into two cohorts, 20 patients underwent immediate one-stage breast reconstruction in the period between October 2019 and January 2021, and 20 patients completed the two-stage reconstructive process in the period prior to October 2019. During the follow-up at 6 months, all patients who had completed the reconstructive process filled out the Breast-Q Reconstruction Module Pre and Postoperative scales questionnaire. The outcomes of the questionnaires were compared between the two cohorts, and statistical analysis was carried out using SPSS Statistics 20 (IBM Corporation, Armonk, NY, USA). RESULTS: The analysis of patient-reported outcomes showed that patients from the one-stage group reported better outcomes in all items evaluated. We did not find statistically significant differences concerning the rate of complications and length of hospital stay between the two groups. CONCLUSIONS: The analysis of the results shows that the outcomes reported by patients who completed breast reconstruction according to our algorithm are statistically better than those with the two-stage technique.

Restore C19 national practice survey: The position of UK delayed breast reconstruction services

Introduction: The offer of immediate breast reconstruction (IBR) was temporarily withdrawn for women requiring mastectomy during the COVID-19 pandemic to allow prioritisation of emergency care. Many women are now awaiting delayed breast reconstruction (DBR) surgery. This survey aimed to explore the current provision of DBR in the UK and how this had been impacted by COVID-19. Method(s): An online survey was distributed to UK breast units via the ABS/Mammary Fold newsletters and social media feeds between 10/2021 and 04/2022. Simple descriptive statistics were used to summarise the results. Result(s): Of the 42 UK breast units that completed the survey, most units reported that COVID-19 had led to increased waits for DBR. Before the pandemic over three quarters of units reported waits of less than 1 year (29% <6 months, 45% 6-12 months) whereas currently waits of 12-24 months are common with a third of units reporting waits of 24-36 months. A small number of units reported waits of >3 years or that DBR had not yet restarted (14%). Key identified challenges for DBR services included limited availability of theatre time and consultant and/or theatre/nursing staff, and a lack of in-patient capacity for post-operative recovery. Conclusion(s): Waiting times for DBR have been negatively impacted by COVID-19. As reconstruction is an integral part of women's breast cancer treatment, there is an urgent need to develop a recovery plan to address this issue, support patients and allow women to access reconstructive surgery in a timely manner.Copyright © 2023

Effect of Covid-19 Pandemic on Female Pelvic Medicine and Reconstructive Surgery Fellowship Case Logs: Analysis of the Accreditation Council of Graduate Medical Education National Data Reports

INTRODUCTION AND OBJECTIVE: Given widespread disruptions to healthcare during the COVID-19 pandemic, the objective was to assess the national case logs of graduating Female Pelvic Medicine and Reconstructive Surgery (FPMRS) fellows for effects on surgical volume. METHOD(S): The nationally aggregated Accreditation Council for Graduate Medical Education case logs were obtained for graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), for available academic years (AYs) 2018-2019, 2019-2020, and 2020- 2021. Standard deviation was derived from percentile data. Case volume differences for tracked index category averages were compared between AYs with one-way analysis of variance. RESULT(S): Graduating fellows logged an average of 517.4 (SD 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. Total surgical procedures were not statistically different between pre-COVID AY 2018- 2019 and COVID-affected AYs 2019-2020 and 2020-2021 for either specialty. For urology fellows, the only index case category with a statistically significant difference was a decrease in AY 2020-2021 compared to 2019-2020 in GI procedures (8.9 vs 4.2, p=0.04). Reclassification of mesh removal cases to genital procedures in 2020- 2021 resulted in a statistical decrease for both specialties of graft/mesh augmentation prolapse cases for that same AY. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSION(S): Compared to pre-pandemic case volumes, FPMRS urology and FPMRS OBGYN graduating fellow surgical volume remained stable. Both total surgical procedures and index case categories showed no statistically significant difference between pre-COVID and COVID-affected years. Despite nationwide disruptions in health care, FPMRS trainee case volumes remained consistent.

Global Plastic Surgery: A Review of the Field and a Call for Virtual Training in Low- and Middle-Income Countries.

Lack of surgical access severely harms countless populations in many low- and middle-income countries (LMICs). Many types of surgery could be fulfilled by the plastic surgeon, as populations in these areas often experience trauma, burns, cleft lip and palate, and other relevant medical issues. Plastic surgeons continue to contribute significant time and energy to global health, primarily by participating in short mission trips intended to provide many surgeries in a short time frame. These trips, while cost-effective for lack of long-term commitments, are not sustainable as they require high initial costs, often neglect to educate local physicians, and can interfere with regional systems. Education of local plastic surgeons is a key step toward creating sustainable plastic surgery interventions worldwide. Virtual platforms have grown popular and effective-particularly due to the coronavirus disease 2019 pandemic-and have shown to be beneficial in the field of plastic surgery for both diagnosis and teaching. However, there remains a large potential to create more extensive and effective virtual platforms in high-income nations geared to educate plastic surgeons in LMICs to lower costs and more sustainably provide capacity to physicians in low access areas of the world.

Le manque d'accès à la chirurgie nuit sévèrement aux vastes populations de nombreux pays à revenus intermédiaires et faibles (PRIF). De nombreux types d'interventions chirurgicales pourraient être exécutés par les chirurgiens plastiques, car les populations de ces régions ont souvent des traumatismes, des brûlures, des fentes labio-palatines et d'autres problèmes médicaux pertinents. La chirurgie plastique continue d'accorder beaucoup de temps et d'énergie à la santé globale, principalement en participant à de courtes missions ayant pour but de résoudre de nombreux problèmes chirurgicaux dans un court laps de temps. Ces voyages, bien que rentables et influenceurs à court terme, n'ont pas d'effet durable, car ils ont des coûts initiaux élevés, négligent souvent d'éduquer les médecins locaux et peuvent perturber les systèmes régionaux. La formation de chirurgiens plastiques locaux est une étape essentielle pour la création d'interventions de chirurgie plastique durables dans le monde. Les plateformes virtuelles sont devenues populaires et efficaces, en particulier à cause de la pandémie de COVID-19, et ont montré leurs avantages dans le champ de la chirurgie plastique en matière de diagnostic et d'enseignement des divers facteurs de chirurgie plastique. Il existe un vaste potentiel pour la création de plateformes virtuelles permettant à des experts des pays à revenus élevés de former des chirurgiens plastiques de PRIF afin d'offrir des moyens plus rentables et durables à ces médecins exerçant dans des régions du monde où l'accès aux soins est plus limité.

An Evaluation of Surgical Management Including Breast Reconstruction During the COVID 19 Pandemic at a Community-Based Academic Hospital

INTRODUCTION: The COVID 19 pandemic caused unprecedented changes in treatment of breast cancer. The aim of this IRB approved retrospective study was to assess trends in surgical management and reconstructive choice after mastectomy during the pandemic. Even as an epicenter at the start of COVID, our hospital prioritized the treatment of breast cancer patients facilitating timely care within accepted standards. METHOD(S): We compared female patients with breast cancer (BC) treated with either lumpectomy (L) or mastectomy (M) during a 12-month period in 2017 and 2020-2021. We stratified based on no reconstruction (NR) versus surgical reconstruction (R), reconstruction using autologous tissue (AT) or tissue expander/implant (TE/I), and age above or below 60 years (< 60, >60). RESULT(S): 399 total patients were treated surgically in 2017 and 2020. In 2017, there were 50 M and 115 L (30.3%/69.7%) versus in 2020, 113 M and 121 L (48.3%/51.7%). In 2017, 9 patients had NR (18.0%) while in 2020, 37 had NR (32.7%). In 2017, 41 had R (82.0%), with 24 receiving AT (58.5%) and 17 had TE/I (41.5%). In 2020, 76 had R (67.3%), with 34 receiving AT (44.7%) and 42 had TE/I (55.3%). For age < 60, 29 had R (70.7%) and 2 had NR (22.2%) in 2017;51 had R (67.1%) and 16 had NR (43.2%) in 2020. For age >60, 12 had R (29.2%) and 7 had NR (77.8%) in 2017;25 had R (32.9%) and 21 had NR (56.8%) in 2020. These data show a 13.8% shift towards TE/I over AT with a 14.7% increase in NR. CONCLUSION(S): Breast cancer patients were prioritized and surgically treated within quality standards. With the changes in availability of hospital resources, staff, and limiting viral exposure, mastectomy rates versus lumpectomy increased dramatically. These trends were possibly due to avoidance of daily facility trips for radiation treatment. Tissue expander/implant rates increased substantially possibly from avoidance of prolonged versus overnight hospital stay. Mastectomy without reconstruction also increased and future studies are needed to determine the number of delayed reconstruction in this group.

Pulmonary artery resection and reconstruction in locally advanced lung cancer with moderate hemoptysis

Lobectomy with pulmonary artery (PA) angioplasty in locally advanced lung cancer is an alternative to pneumonectomy. It is feasible, oncologically effective and the procedure of choice in patients with recurrent hemoptysis and limited pulmonary reserves. We present a case of a successful left upper lobectomy with PA resection and reconstruction by an autologous pericardial patch.Copyright © 2022 EDIZIONI MINERVA MEDICA.

EE175 Budget Impact Assessment of Knee Orthoses Funding in Patients With Osteoarthritis of the Knee Considering Total Knee Reconstructive Surgery: Private Australian Payer Perspective

Objectives: To determine the budget impact if knee orthoses were funded for patients with severe osteoarthritis (OA) of the knee from a private Australian payer perspective. Method(s): The ISPOR Principles of Good Practice were used to guide a budget impact analysis comparing the use of knee orthoses to delay total knee reconstruction (TKR) versus the current environment. Delayed TKR was estimated based on a systematic review of electronic databases and a web-based search. Utilisation for TKR (sourced from Australian Medical Benefits Schedule statistics) was projected over the time horizon (2023 to 2027). The clinically eligible (i.e., target) population was based on the proportion of patients with OA of the knee in a large US cohort (N=8,002) deemed to have had TKR prematurely. The cost of TKR was based on Australian hospital separation data. Result(s): Funding of knee orthoses was associated with a cost-saving of $AUD122 to $AUD126 million over a 5-year time horizon based on device costs of $AUD500 and $AUD395, respectively. The cost-savings were primarily driven by 18,000 delayed TKR procedures. Knee orthosis, such as the Thuasne OA, were also associated with improvements in clinical outcomes including pain-free walk distance, pain during exercise, and lequesne index score (P<0.005). Conclusion(s): The widespread prevalence of COVID-19 has disrupted the capacity for Australian hospitals to undertake elective surgeries. The median wait-list time for TKR, which accounted for 47,000 surgeries in 2020-2021, increased from 223 to 308 days in Australia between 2019-2020 to 2020-2021. Our research indicates that the funding of appropriate knee orthoses in patients with severe OA has a cost-saving budget impact while offering potential clinical improvement for patients and reduced pressure on elective surgery wait lists.Copyright © 2022

Early detection of recurrent HPV+ hypopharyngeal squamous cell carcinoma by circulating tumor DNA

Circulating tumor DNA is a liquid biomarker that offers a highly specific method to assess HPV-associated tumor burden via a blood draw. It has the potential for many clinical applications in cancer care, including prognostication, monitoring treatment response, and surveillance for disease recurrence. In this case report, we present a case of recurrent HPV-associated hypopharyngeal squamous cell carcinoma first detected by circulating tumor HPV DNA that demonstrates the role of circulating tumor HPV DNA tests in posttreatment surveillance and the utility of HPV testing in all HPV-mediated tumors, regardless of subsite.Copyright © 2023 Elsevier Inc.

Endovascular embolisation of a complex mandibular AVM: a hybrid transarterial and transvenous approach.

Mandibular arteriovenous malformations (AVMs) are rare lesions which can present with life-threatening haemorrhage. Endovascular embolisation can be life saving for these patients. We discuss a patient of mandibular AVM, who initially presented with reports of massive oral bleeding. The lesion was only partially embolised via transarterial route, as the nidus could not be penetrated completely. In view of rebleeding within 72 hours from the same site, a second embolisation procedure was done via combined, transarterial and transvenous approaches. Coils and onyx were used as embolising agents. Complete embolisation was achieved via combined approach. No further bleeding episodes were seen at 1-year follow-up. Endovascular embolisation of mandibular AVMs can be technically challenging and, hence, a sound knowledge of the anatomy as well as the possible modification of technique is essential to achieve complete obliteration of the lesion and to maximise the benefit of embolisation and to avoid major radical surgery.

Life threatening non-accidental burns, pandemic dependent telemedicine, and successful use of cultured Zurich Skin in a neonate - A case report

Life threatening burns of non-accidental origin in neonates are extremely rare. Their management represents a great challenge, particularly since necrosectomy of deep burns and grafting at this young age are technically very demanding. Thus, a strategic surgical master plan is mandatory to achieve rapid and definitive autologous coverage and avoidance of undue risks and iatrogenic burden for the fragile neonatal patient. We present the case of a four day-old neonate who sustained non-accidental deep burns involving 40 % of its total body surface area (TBSA) and the successful application of a laboratory grown, autologous dermo-epidermal skin analogue, termed Zurich Skin (also named denovoSkin), within a clinical trial sub-study. Due to COVID-19 pandemic restrictions, a telemedicine-based approach was installed and a total of 260 cm2 Zurich Skin were transplanted, video assisted, on a wound bed previously prepared with a dermal substitute, thereby covering 20 % TBSA. Take of Zurich Skin was excellent on the chest, good to moderate on the abdomen, and poor on other small areas, where we observed a prolonged healing. After maturation, Zurich Skin showed a close to natural skin coverage without need for further reconstructive surgery. This unique case delivers the proof of concept that Zurich Skin can be successfully applied in early life and even under most adverse medical and paramedical circumstances, provided a carefully crafted masterplan properly addressing the key issues can be executed by joint forces of committed partner institutions.Copyright © 2023 The Authors

The impact of COVID-19 on plastic and reconstructive surgery in China: A single-centre retrospective study.

BACKGROUND: This study aimed to investigate the volume of plastic surgery operations in a large public hospital and figure out the changes in the related factors associated with Coronavirus Disease 2019 (COVID-19) and identify the potential problems. METHODS: We created a survey and collected clinical data from 1 January 2018 to 31 December 2020. Information on procedure time, patient gender, patient age, and procedure type was collected from the database. The data were analysed using IBM SPSS Statistics for Windows, version 25.0. RESULTS: A total of 10,827 patients were admitted to our department. The total number of patients decreased by 21.53% in 2020 (3057 cases) than the same period in 2019 (3896 cases). The total number of aesthetic procedures decreased by 34.17% in 2020 than that in 2019. However, restorative procedures in 2020 (2013 cases) only decreased by 12.86% than that in 2019 (2310 cases). The percentages of women amongst patients who underwent aesthetic procedures were 91.75%, 92.18%, and 90.71% in 2018, 2019, and 2020, respectively. Most of the patients in these three years were aged 20-29 years. CONCLUSIONS: The plastic surgery industry is experiencing the effects of the unprecedented COVID-19 pandemic worldwide. COVID-19 was quickly brought under control, and the plastic surgery industry developed rapidly in China because of the active, timely, and accurate implementation of epidemic prevention strategies.

Outcomes of Closed versus Open Rhinoplasty: A Systematic Review.

Open and closed rhinoplasty are two main approaches to perform nasal modifications. According to current literature, there is no current consensus among plastic surgeons and otolaryngologists on which technique is preferred in terms of aesthetic result, complications, and patient satisfaction. This study uses published research to determine whether open or closed rhinoplasty leads to superior patient outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed and a literature search was conducted in four databases based on our search strategy. Articles were then imported into COVIDENCE where they underwent primary screening and full-text review. Twenty articles were selected in this study after 243 articles were screened. There were 4 case series, 12 retrospective cohort studies, 1 prospective cohort study, 1 case-control, and 2 outcomes research. There were three cosmetic studies, eight functional studies, and nine studies that included both cosmetic and functional components. Sixteen studies utilized both open and closed rhinoplasty and four utilized open rhinoplasty. Both techniques demonstrated high patient and provider satisfaction and no advantage was found between techniques. Based on available studies, we cannot conclude if there is a preference between open or closed rhinoplasty in terms of which technique leads to better patient outcomes. Several studies determined that open rhinoplasty and closed rhinoplasty leads to comparative patient satisfaction. To make outcome reporting more reliable and uniform among studies, authors should look to utilize the Nasal Obstruction and Septoplasty Effectiveness scale and the Rhinoplasty Outcome Evaluation.

VIDEO GUIDED PELVIC PHYSICAL THERAPY FOR STRESS URINARY INCONTINENCE

Introduction: Pelvic Floor Physical Therapy (PFPT) is a first-line treatment for stress urinary incontinence according to expert guidance, including the American Urogynecologic Society. Barriers such as cost, time commitment, motivation, and uncertainty of efficacy have been previously identified. These barriers make access to PFPT difficult for many. Additionally, those who are motivated may not receive timely care due to the current coronavirus pandemic. Objective: The objective of this video is to detail evidence-based PFPT exercises known to be effective in treating SUI. Methods: This animation film is a multidisciplinary effort and has been developed in collaboration with female pelvic medicine and reconstructive surgery clinicians, PFPT providers, and students in cinematic arts. Results: The PFPT exercises include five sections and follow the order of recommendations by our institution's PFPT. These include diaphragmatic breathing, Kegel exercises, bridge with Kegels, leg raises, and squat with Kegels. Conclusions: This video was created as an additional resource for patients with limited access to PFPT, especially given current limitations due to the coronavirus pandemic. The video is part of a single-blinded randomized controlled trial comparing video-guided PFPT versus a routine informational video on SUI. Both videos will be in English and Spanish. Eventually, the goal is for more widespread distribution and increased accessibility for all patients.

THE IMPACT OF ERAS ON FPMRS OUTCOMES AT A PUBLIC TEACHING HOSPITAL DURING THE COVID-19 PANDEMIC

Introduction: Enhanced recovery after surgery (ERAS) protocols have decreased hospital length of stay (LOS) and increased the rate of same-day discharge in patients undergoing minimally invasive surgery, including in female pelvic medicine and reconstructive surgery (FPMRS). In October of 2019, our hospital implemented an ERAS protocol;however, the onset of the COVID-19 epidemic accelerated the need to adopt a same day discharge policy. Given the rapid implementation of this policy, it was important to determine its effect on FPMRS surgical outcomes in a public teaching hospital serving predominantly uninsured and underinsured patients. Objective: The primary objective of this study was to evaluate perioperative management and postoperative outcomes for FPMRS patients after implementation of an ERAS protocol in a public teaching hospital. Methods: A single-center review was performed of FPMRS patients undergoing surgery prior to introduction of the ERAS protocol from January 2019 to June 2019 compared to those undergoing surgery after its implementation from January 2021 to June 2021. Demographic and surgical details were collected for all patients. A retrospective analysis was performed comparing outcomes, including percentage of outpatient surgery, emergency department visits within 30 days of surgery, and opioid use pre- and post-ERAS implementation Results: 29 patients were included in the pre-implementation group and 19 patients were included in the post-ERAS implementation group. Procedure types and patient demographics are seen in table 1. Ninety-three percent of patients self-described as Hispanic/Latino ethnicity. The percentage of outpatient surgeries increased from 17% to 90% (p < 0.01). Preoperative acetaminophen use increased from 3% to 74% of patients (p < 0.01), while mean perioperative morphine milligram equivalents decreased from 57 mg to 42 mg (p < 0.01). Mean opioid pills prescribed was not different after implementation of ERAS. Thirty-day emergency department (ED) returns increased from 0% to 11% (P = 0.15). These two ED returns included one visit for a urinary tract infection and the other for nephrolithiasis. Conclusions: ERAS implementation for FPMRS patients at a public hospital led to a significant decrease in LOS, inpatient admission, and perioperative morphine milligram equivalents used without a significant increase in 30-day ED returns. While the COVID-19 epidemic resulted in an accelerated adoption of ERAS protocol, it was found to be safe and effective in our underserved FPMRS patient population.

'A Procedure Without a Problem', or the face transplant that didn't happen. The Royal Free, the Royal College of Surgeons and the challenge of surgical firsts.

Face transplants are an innovative and unusual form of modern surgery. There have been 47 face transplants around the world to date, but none as yet in the UK. Yet in 2003, the UK was poised to undertake the first face transplant in the world. The reasons why it didn't take place are not straightforward, but largely unexplored by historians. The Royal College of Surgeons, concerned about the media attention given to face transplants and the ethical and surgical issues involved, held a working party and concluded that it could not give approval for face transplants, effectively bringing to a halt the UK's momentum in the field. This extraordinary episode in medical history has been anecdotally influential in shaping the course of British surgical history. This article explores and explains the lack of a face transplant in the UK and draws attention to the complex emotional, institutional and international issues involved. Its findings have implications beyond the theme of face transplants, into the cultural contexts and practices in which surgical innovation takes place.

Patient satisfaction and savings, and clinical outcomes of televisits in female pelvic medicine and reconstructive surgery at an urban academic center.

AIM: To evaluate patient satisfaction and savings, and compare visit outcomes based on chief complaint (CC) of women presenting for a televisit to a female pelvic medicine and reconstructive surgery (FPMRS) clinic at an urban academic center. METHODS: A cross-sectional study of women completing a televisit with an FPMRS specialist at our institution from June 19, 2020 to July 17, 2020 was conducted. A telephone questionnaire was administered to patients to assess satisfaction and savings (travel costs/time avoided). Electronic medical records were reviewed to collect patient demographics and comorbidities, CC, and televisit outcomes (e.g., face-to-face (F2F) exam scheduled, orders placed). Logistic regression was used to analyze predictors of satisfaction and need for F2F follow-up. RESULTS: One hundred eighty-seven of 290 (64.5%) women called completed the survey, of whom 168 (89.8%) were satisfied with their televisit. Eighty-eight (48.1%) saved at least an hour and 54 (28.9%) saved more than $25 on transportation. There were no significant associations between patient characteristics, CC, or televisit outcomes and satisfaction. Ninety-nine (52.9%) televisits resulted in F2F follow-up, with CC of prolapse (odds ratio [OR] = 4.2 (1.7-10.3); p = 0.002), new patient (OR = 2.2 (1.2-4.2); p = 0.01), and Hispanic ethnicity (OR = 3.9 (1.2-13.6); p=.03) as significant predictors. CONCLUSION: Most patients were satisfied with FPMRS televisits at our urban academic center. Televisits resulted in patient travel time and cost savings. Women presenting with prolapse and for new patient visits would likely benefit from initial F2F visits instead of televisits. Televisits are an important mode of health care and in some cases can replace F2F visits.

Effects of 1-year COVID-19 pandemic on head and neck cancer stage and treatment duration

Introduction The imposed radical governmental restrictions to combat the pandemic and the overstrained medical resources affected greatly, not only those infected from the novel virus, but also miscellaneous patient groups. Aim of this study was the assessment of the efficacy of oncologic healthcare during Covid-19 pandemic on patients with head neck squamous cell carcinoma in a tertiary university hospital in Germany. Material and Methods This retrospective, cross-sectional, observational study included 94 patients with newly diagnosed head and neck squamous cell carcinoma during a two-year period. Patients were assigned to two date-dependent groups;referrals before (Group A) and during (Group B) the Covid-19 pandemic. Time intervals from symptom(s) onset to diagnosis, diagnosis to treatment and treatment initiation to completion were recorded. Furthermore, TNM-stages and application of reconstructive surgery with free tissue transfer were determined. Results Despite the challenges and burden of the pandemic, tumor upstaging and treatment delays could not be observed. Conclusion A timely diagnosis and treeatment initiation plays a major role in prognosis of patients withs head and neck squamous cell carcinoma.

The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units' practice during the state of alarm in 2020: National survey.

INTRODUCTION: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as "non-urgent" (andrology and reconstructive surgery) were postponed or even unattended. MATERIAL AND METHODS: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. RESULTS: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). CONCLUSIONS: The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined.