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1.
Urologe A ; 60(3): 291-300, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1453684

ABSTRACT

Urologic cancer care needs to be prioritized despite multiple health care restrictions during the coronavirus disease 2019 (COVID-19) pandemic. However, therapies and procedures may be delayed and complicated. In Germany, analysis of the multiple cancer registries provides insights into the actual numbers of treated patients. We provide a review on the registration of urologic cancer care during the first wave of the COVID-19 pandemic in Germany and on potential surgical complications of urologic interventions. We found that during the year 2020 there were generally fewer registrations of newly diagnosed patients with major urologic neoplasms in a representative federal database. The number of surgical interventions in patients with renal cell carcinoma and urothelial bladder cancer decreased, whereas equal numbers of radical prostatectomies were performed when compared to the year 2019. COVID-19 may increase non-urological postoperative complications following surgical treatment of urologic malignancies; however, available data are still very limited.


Subject(s)
COVID-19 , Urologic Neoplasms , Germany/epidemiology , Humans , Pandemics , SARS-CoV-2 , Urologic Neoplasms/epidemiology
2.
Urologia ; 88(1): 3-8, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1105635

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Subject(s)
COVID-19/epidemiology , Continuity of Patient Care , Health Services Accessibility , Medical Oncology/statistics & numerical data , Pandemics , SARS-CoV-2 , Urologic Surgical Procedures/statistics & numerical data , Urology/statistics & numerical data , Appointments and Schedules , Female , Health Care Surveys , Humans , Italy/epidemiology , Kidney Neoplasms/epidemiology , Kidney Neoplasms/surgery , Male , Medical Oncology/organization & administration , Procedures and Techniques Utilization , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/surgery , Urinary Bladder Neoplasms/epidemiology , Urinary Bladder Neoplasms/surgery , Urologic Neoplasms/epidemiology , Urologic Neoplasms/surgery , Urology/organization & administration
3.
Prog Urol ; 31(12): 716-724, 2021 Oct.
Article in French | MEDLINE | ID: covidwho-1104233

ABSTRACT

INTRODUCTION: Faced with the first wave of Covid-19 pandemic, guidelines for surgical triage were developed to free up healthcare resources. The aim of our study was to assess clinical characteristics and surgical outcomes of triaged patients during the first Covid-19 crisis. METHOD: We conducted a cohort-controlled, non-randomized, study in a University Hospital of south-eastern France. Data were collected prospectively from consecutive patients after triage during the period from March 15th to May 1st and compared with control data from outside pandemic period. Primary endpoint was intensive care unit (ICU) admissions for surgery-related complications. Rates of surgery-specific death, postponed operations, positive PCR testing and Clavien-Dindo complications and data from cancer and non- cancer subgroups were assessed. RESULTS: After triage, 96 of 142 elective surgeries were postponed. Altogether, 71 patients, median age 68 y.o (IQR: 56-75 y.o), sex ratio M/F of 4/1, had surgery, among whom, 48 (68%) had uro-oncological surgery. No patients developed Covid-19 pneumonia in the post-surgery period. Three (4%) were admitted to the ICU, one of whom died from multi-organ failure due to septic shock caused by klebsiella pneumonia following a delay in treatment. Three Covid-19 RT-PCR were done and all were negative. There was no difference in mortality rates or ICU admission rates between control and Covid- era patients. CONCLUSIONS: Surgery after triage during the first Covid-19 pandemic was not associated with worse short-term outcomes. Urological cancers could be operated on safely in our context but delays in care for aggressive genitourinary diseases could be life threatening. LEVEL OF EVIDENCE: 3.


Subject(s)
COVID-19/epidemiology , Pandemics , Triage/organization & administration , Urologic Diseases/surgery , Urologic Neoplasms/surgery , Aged , COVID-19 Testing , Cohort Studies , Female , France/epidemiology , Hospitalization , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Patient Admission/statistics & numerical data , Patient Readmission/statistics & numerical data , Urologic Diseases/epidemiology , Urologic Neoplasms/epidemiology
4.
Urologe A ; 60(3): 291-300, 2021 Mar.
Article in German | MEDLINE | ID: covidwho-1070815

ABSTRACT

Urologic cancer care needs to be prioritized despite multiple health care restrictions during the coronavirus disease 2019 (COVID-19) pandemic. However, therapies and procedures may be delayed and complicated. In Germany, analysis of the multiple cancer registries provides insights into the actual numbers of treated patients. We provide a review on the registration of urologic cancer care during the first wave of the COVID-19 pandemic in Germany and on potential surgical complications of urologic interventions. We found that during the year 2020 there were generally fewer registrations of newly diagnosed patients with major urologic neoplasms in a representative federal database. The number of surgical interventions in patients with renal cell carcinoma and urothelial bladder cancer decreased, whereas equal numbers of radical prostatectomies were performed when compared to the year 2019. COVID-19 may increase non-urological postoperative complications following surgical treatment of urologic malignancies; however, available data are still very limited.


Subject(s)
COVID-19 , Urologic Neoplasms , Germany/epidemiology , Humans , Pandemics , SARS-CoV-2 , Urologic Neoplasms/epidemiology
5.
World J Urol ; 39(9): 3139-3145, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-630691

ABSTRACT

OBJECTIVES: While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic. METHODS: In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated. RESULTS: 235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21-24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02). CONCLUSION: The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic.


Subject(s)
COVID-19 , Practice Patterns, Physicians' , Triage , Urologic Neoplasms , Urologic Surgical Procedures , COVID-19/epidemiology , COVID-19/prevention & control , Cross-Sectional Studies , Global Health/statistics & numerical data , Humans , Infection Control/methods , Medical Oncology/methods , Medical Oncology/organization & administration , Medical Oncology/trends , Needs Assessment , Organizational Innovation , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/trends , SARS-CoV-2 , Time-to-Treatment/statistics & numerical data , Triage/organization & administration , Triage/trends , Urologic Neoplasms/epidemiology , Urologic Neoplasms/therapy , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data
6.
Clin Oncol (R Coll Radiol) ; 32(6): 347-353, 2020 06.
Article in English | MEDLINE | ID: covidwho-116897

ABSTRACT

The current COVID-19 pandemic presents a substantial obstacle to cancer patient care. Data from China as well as risk models suppose that cancer patients, particularly those on active, immunosuppressive therapies are at higher risks of severe infection from the illness. In addition, staff illness and restructuring of services to deal with the crisis will inevitably place treatment capacities under significant strain. These guidelines aim to expand on those provided by NHS England regarding cancer care during the coronavirus pandemic by examining the known literature and provide guidance in managing patients with urothelial and rarer urinary tract cancers. In particular, they address the estimated risk and benefits of standard treatments and consider the alternatives in the current situation. As a result, it is recommended that this guidance will help form a framework for shared decision making with patients. Moreover, they do not advise a one-size-fits-all approach but recommend continual assessment of the situation with discussion within and between centres.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Immunocompromised Host , Pneumonia, Viral/epidemiology , Urologic Neoplasms/epidemiology , Urologic Neoplasms/therapy , COVID-19 , Coronavirus Infections/therapy , England , Humans , Pandemics , Pneumonia, Viral/therapy , SARS-CoV-2
7.
Eur Urol ; 78(1): 11-15, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-48026

ABSTRACT

The coronavirus 2019 (COVID-19) pandemic has led to an unprecedented emergency scenario for all aspects of health care, including urology. At the time of writing, Italy was the country with the highest rates of both infection and mortality. A panel of experts recently released recommendations for prioritising urologic surgeries in a low-resource setting. Of note, major cancer surgery represents a compelling challenge. However, the burden of these procedures and the impact of such recommendations on urologic practice are currently unknown. To fill this gap, we assessed the yearly proportion of high-priority major uro-oncologic surgeries at three Italian high-volume academic centres. Of 2387 major cancer surgeries, 32.3% were classified as high priority (12.6% of radical nephroureterectomy, 17.3% of nephrectomy, 33.9% of radical prostatectomy, and 36.2% of radical cystectomy cases). Moreover, 26.4% of high-priority major cancer surgeries were performed in patients at higher perioperative risk (American Society of Anesthesiologists score ≥3), with radical cystectomy contributing the most to this cohort (50%). Our real-life data contextualise ongoing recommendations on prioritisation strategies during the current COVID-19 pandemic, highlighting the need for better patient selection for surgery. We found that approximately two-thirds of elective major uro-oncologic surgeries can be safely postponed or changed to another treatment modality when the availability of health care resources is reduced. PATIENT SUMMARY: We used data from three high-volume Italian academic urology centres to evaluate how many surgeries performed for prostate, bladder, kidney, and upper tract urothelial cancer can be postponed in times of emergency. We found that approximately two-thirds of patients with these cancers do not require high-priority surgery. Conversely, of patients requiring high-priority surgery, approximately one in four is considered at high perioperative risk. These patients may pose challenges in allocation of resources in critical scenarios such as the current COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Hospitals, High-Volume/statistics & numerical data , Pandemics , Pneumonia, Viral/complications , Referral and Consultation , Urologic Neoplasms/surgery , Urologic Surgical Procedures/trends , COVID-19 , Coronavirus Infections/epidemiology , Humans , Italy/epidemiology , Morbidity/trends , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Urologic Neoplasms/complications , Urologic Neoplasms/epidemiology
8.
Eur Urol Oncol ; 3(3): 259-261, 2020 06.
Article in English | MEDLINE | ID: covidwho-47181
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