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1.
Neurourol Urodyn ; 41(2): 643-649, 2022 02.
Article in English | MEDLINE | ID: covidwho-1616037

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) pandemic has caused a massive cutdown in outpatient urological investigations, procedures, and interventions. Female and functional urology (FFU) has been probably the most affected subspecialty in urology. Several scientific societies have published guidelines to manage this new situation, providing general recommendations. The aim of this study was to devise a robust questionnaire covering every different aspect of FFU to obtain recommendations on COVID-19 adaptations. METHODS: Delphi methodology was adapted to devise the survey questionnaires for male/female lower urinary tract symptoms (LUTS), pelvic organ prolapse (POP), chronic pelvic pain (CPP), and neuro-urological disease. Content validity, face validity, and internal consistence were assessed to establish the final questionnaire. This study was ethically approved by the Local Research Ethics Committee. RESULTS: A total 97, 59, 79, 85, and 84 items for female and male LUTS, POPs, CPP, and neuro-urology respectively were approved by the participants. Content validity over 0.70 was obtained which seemed reasonable content validity scores. Internal consistency obtains values of Cronbach's alpha was between 0.70 and 0.90 which was acceptable. CONCLUSIONS: The collective wisdom obtained through a global survey using validated questionnaires covering every different aspect of FFU patient management is necessary. We have developed a robust and validated tool consisting of five questionnaires covering the most prevalent pathologies in FFU.


Subject(s)
COVID-19 , Urology , Female , Humans , Male , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires , Urologic Surgical Procedures/methods
3.
Hong Kong Med J ; 27(4): 258-265, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1106524

ABSTRACT

INTRODUCTION: The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003. METHODS: Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period. RESULTS: The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002). CONCLUSION: A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Internship and Residency , Practice Patterns, Physicians' , Severe Acute Respiratory Syndrome/epidemiology , Urologic Surgical Procedures , Urology , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Disease Outbreaks/statistics & numerical data , Hong Kong/epidemiology , Humans , Internship and Residency/methods , Internship and Residency/organization & administration , Organizational Innovation , Practice Patterns, Physicians'/organization & administration , Practice Patterns, Physicians'/trends , SARS-CoV-2 , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data , Urology/education , Urology/statistics & numerical data
4.
BJU Int ; 126(6): 670-678, 2020 12.
Article in English | MEDLINE | ID: covidwho-998799

ABSTRACT

OBJECTIVE: To assess the risk of viral infection during urological surgeries due to the possible hazards in tissue, blood, urine and aerosolised particles generated during surgery, and thus to understand the risks and make recommendations for clinical practice. PATIENTS AND METHODS: We reviewed the available literature on urological and other surgical procedures in patients with virus infections, such as human papillomavirus, human immunodeficiency virus and hepatitis B, and current publications on coronavirus disease 2019 (COVID-19). RESULTS: Several possible pathways for viral transmission appear in the literature. Recently, groups have detected severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosol-borne and present a certain risk of transmission and infection. However, there is currently no evidence on the exact risk of infection from the agents mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious. CONCLUSIONS: Whether SARS-CoV-2 can be transmitted by aerosols remains controversial. Irrespective of this, standard surgical masks offer inadequate protection from SARS-CoV-2. Full personal protective equipment, including at least filtering facepiece-2 masks and safety goggles should be used. Aerosolised particles might remain for a long time in the operating theatre and contaminate other surfaces, e.g. floors or computer input devices. Therefore, scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolisation during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus-proof high-efficiency particulate air filters is recommended. Local separation of anaesthesia/intubation and the operating theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID-19 is not a contraindication for acute urological surgery. However, if possible, as European guideline committees recommend, non-emergency urological interventions should be postponed until negative SARS-CoV-2 tests become available.


Subject(s)
COVID-19/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Urologic Surgical Procedures/adverse effects , Aerosols , Contraindications , Feces/virology , Filtration , Humans , Infection Control , Laparoscopy/adverse effects , Laparoscopy/methods , Operating Rooms/standards , Personal Protective Equipment , Practice Guidelines as Topic , RNA, Messenger/analysis , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Urologic Surgical Procedures/methods , Virus Diseases/prevention & control , Virus Diseases/transmission
5.
Urol Oncol ; 39(5): 258-267, 2021 05.
Article in English | MEDLINE | ID: covidwho-894253

ABSTRACT

The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.


Subject(s)
COVID-19/prevention & control , Medical Oncology/methods , SARS-CoV-2/isolation & purification , Urogenital Neoplasms/surgery , Urologic Neoplasms/surgery , Urologic Surgical Procedures/methods , Adult , Aged , COVID-19/epidemiology , COVID-19/virology , Humans , Male , Medical Oncology/statistics & numerical data , Middle Aged , Neoplasm Staging , Outcome Assessment, Health Care/methods , Outcome Assessment, Health Care/statistics & numerical data , Pandemics , Penile Neoplasms/pathology , Penile Neoplasms/surgery , SARS-CoV-2/physiology , Testicular Neoplasms/pathology , Testicular Neoplasms/surgery , Time-to-Treatment , Urogenital Neoplasms/pathology , Urologic Neoplasms/pathology
6.
Int Braz J Urol ; 46(suppl.1): 215-221, 2020 07.
Article in English | MEDLINE | ID: covidwho-818693

ABSTRACT

Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.


Subject(s)
Coronavirus Infections/complications , Disease Transmission, Infectious/prevention & control , Laparoscopy/methods , Pandemics , Pneumonia, Viral/complications , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , Urologists , Urology , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Robotic Surgical Procedures/trends , SARS-CoV-2 , Urologic Surgical Procedures/trends , Urology/standards , Urology/trends , Workflow
8.
Urol Oncol ; 39(5): 298.e7-298.e11, 2021 05.
Article in English | MEDLINE | ID: covidwho-779731

ABSTRACT

OBJECTIVES: To assess potential nosocomial coronavirus disease-2019 (COVID-19) transmission in patients who underwent robot-assisted laparoscopic procedures during the pandemic. MATERIAL AND METHODS: Prospective study in patients undergoing robot-assisted laparoscopy in urology or gynaecology within 2 academic hospitals. Patients underwent local preoperative COVID-19 screening using a symptoms questionnaire. Patients with suspicious screening underwent coronavirus real time-polymerase chain reaction (RT-PCR) and were excluded from robotic surgery if positive. Patients with symptoms postsurgery were systematically tested for coronavirus by RT-PCR. One-month postsurgery, all patients had a telephone consultation to evaluate COVID-19 symptoms. RESULTS: Sixty-eight patients underwent robotic surgery during the study period (median age: 63-years [IQR: 53-70], 1.8 male: female ratio). Oncology was the main indication for robotic surgery (n = 62, 91.2%) and 26 patients (38.2%) received a chest CT-scan prior to surgery. Eleven patients (16.2%) were symptomatic after surgery of whom only 1 tested positive for coronavirus by RT-PCR (1.5%) and was transferred to COVID-19 unit with no life-threatening condition. No attending surgeon was diagnosed with COVID-19 during the study. CONCLUSIONS: Robot-assisted laparoscopic surgery seemed safe in the era of COVID-19 as long as all recommended precautions are followed. The rate of nosocomial COVID-19 transmission was extremely low despite the fact that we only used RT-PCR testing in symptomatic patients during the preoperative work-up. Larger cohort is needed to validate these results.


Subject(s)
COVID-19/transmission , Cross Infection/diagnosis , Robotic Surgical Procedures/methods , SARS-CoV-2/isolation & purification , Surveys and Questionnaires/statistics & numerical data , Academic Medical Centers , Aged , COVID-19/epidemiology , COVID-19/virology , Female , Gynecologic Surgical Procedures/methods , Gynecologic Surgical Procedures/statistics & numerical data , Humans , Laparoscopy/methods , Male , Middle Aged , Pandemics/prevention & control , Postoperative Period , Prospective Studies , Robotic Surgical Procedures/statistics & numerical data , SARS-CoV-2/physiology , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data
10.
BJU Int ; 126(4): 436-440, 2020 10.
Article in English | MEDLINE | ID: covidwho-703610
11.
Urology ; 145: 73-78, 2020 11.
Article in English | MEDLINE | ID: covidwho-695345

ABSTRACT

OBJECTIVE: To assess the outreach and influence of the main recommendations of surgical governing bodies on adaptation of minimally invasive laparoscopic surgery (MIS) procedures during the coronavirus disease 2019 (COVID-19) pandemic in an anonymized multi-institutional survey. MATERIALS AND METHODS: International experts performing MIS were selected on the basis of the contact database of the speakers of the Friends of Israel Urology Symposium. A 24-item questionnaire was built using main recommendations of surgical societies. Total cases/1 Mio residents as well as absolute number of total cases were utilized as surrogates for the national disease burden. Statistics and plots were performed using RStudio v0.98.953. RESULTS: Sixty-two complete questionnaires from individual centers performing MIS were received. The study demonstrated that most centers were aware of and adapted their MIS management to the COVID-19 pandemic in accordance to surgical bodies' recommendations. Hospitals from the countries with a high disease burden put these adoptions more often into practice than the others particularly regarding swabs as well as CO2 insufflation and specimen extraction procedures. Twelve respondents reported on presumed severe acute respiratory syndrome coronavirus 2 transmission during MIS generating hypothesis for further research. CONCLUSION: Guidelines of surgical governing bodies on adaptation of MIS during the COVID-19 pandemic demonstrate significant outreach and implementation, whereas centers from the countries with a high disease burden are more often poised to modify their practice. Rapid publication and distribution of such recommendation is crucial during future epidemic threats.


Subject(s)
COVID-19/epidemiology , Guideline Adherence/statistics & numerical data , Laparoscopy/standards , Robotic Surgical Procedures/standards , SARS-CoV-2 , Urologic Surgical Procedures/standards , Health Care Surveys , Humans , Internationality , Laparoscopy/statistics & numerical data , Minimally Invasive Surgical Procedures/standards , Practice Guidelines as Topic , Practice Patterns, Physicians' , Robotic Surgical Procedures/statistics & numerical data , Societies, Medical , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data , Urology
12.
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
13.
Int Urol Nephrol ; 52(11): 2059-2064, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-613477

ABSTRACT

PURPOSE: It is reported that surgical procedures performed during the COVID-19 pandemic are accompanied by high complications and risks. In this study, the urological interventions applied with appropriate infrastructure and protocols during the pandemic in the pandemic hospital that is carrying out the COVID-19 struggle are analyzed. METHODS: Urological interventions were reviewed in the 5-week period between March 11 and April 16. The distribution of outpatient and interventional procedures was determined by weeks concurrently along with the COVID-19 patient workload, and data in the country, subgroups were further analyzed. Patients intervened were divided into four groups as Emergency, High, Intermediate, and Low Priority cases according to the EAU recommendations. The COVID-19-related findings were recorded; staff and patient effects were reported. RESULTS: Of the 160 interventions, 65 were minimally invasive or open surgical intervention, 95 were non-surgical outpatient intervention, and the outpatient admission was 777. According to the priority level, 33 cases had emergency and high priority, 32 intermediate and low priority. COVID-19 quarantine and follow-up were performed at least 1 week in 22 (33.8%) operated patients at the last week, 43 (66.2%) patients who were operated in the previous 4 weeks followed up at least 2 weeks. No postoperative complications were encountered in any patient due to COVID-19 during the postoperative period. CONCLUSION: In the COVID-19 pandemic, precautions, isolation, and algorithms are required to avoid disruption in the intervention and follow-up of urology patients; priority urological interventions should not be disrupted in the presence of necessary experience and infrastructure.


Subject(s)
Ambulatory Care , Ambulatory Surgical Procedures , Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral , Urologic Diseases , Urologic Surgical Procedures , Ambulatory Care/methods , Ambulatory Care/statistics & numerical data , Ambulatory Surgical Procedures/methods , Betacoronavirus , COVID-19 , Change Management , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Emergency Treatment/methods , Emergency Treatment/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Male , Middle Aged , Minimally Invasive Surgical Procedures/statistics & numerical data , Outcome and Process Assessment, Health Care , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Turkey/epidemiology , Urologic Diseases/epidemiology , Urologic Diseases/surgery , Urologic Surgical Procedures/methods , Urologic Surgical Procedures/statistics & numerical data
14.
Eur Urol Focus ; 6(5): 1104-1110, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-598746

ABSTRACT

BACKGROUND: Determining whether members follow guidelines, including guidelines prepared to help direct practice management during the coronavirus disease 2019 (COVID-19) pandemic, is an important goal for medical associations. OBJECTIVE: To determine whether practice of urologists is in line with guidelines for the management of common urological conditions during the COVID-19 pandemic produced by leading (inter)national urological associations. DESIGN, SETTING, AND PARTICIPANTS: Self-selected urologists completed a voluntary survey available online from March 27 to April 11, 2020 and distributed globally by the Société Internationale d'Urologie. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Responses to two survey questions on the (1) management of 14 common urological procedures and (2) priority scoring of 10 common urological procedures were evaluated by practice setting and geographical region using chi-square and one-way analysis of variance analyses, respectively. RESULTS AND LIMITATIONS: There were 2494 respondents from 76 countries. Oncological conditions were prioritised over benign conditions, and benign conditions were deferred when feasible and safe. Oncological conditions with the greatest malignant potential were prioritised over less aggressive cancers. Respondents from Europe were least likely to postpone and most likely to prioritise conditions identified by guidelines as being of the highest priority. Respondents' priority scoring of urological procedures closely matched the priorities assigned by guidelines. The main limitation of this study is that respondents were self-selected, and access to the survey was limited by language and technology barriers. CONCLUSIONS: Prioritisation and management of urological procedures during the COVID-19 pandemic are in line with current guidelines. The greatest agreement was reported in Europe. Observed differences may be related to limited resources in some settings. PATIENT SUMMARY: When deciding how best to treat patients during the coronavirus disease 2019 (COVID-19) pandemic, urologists are taking into account both expert recommendations and the availability of important local resources.


Subject(s)
Coronavirus Infections/epidemiology , Guideline Adherence/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Urogenital Neoplasms/surgery , Urologic Diseases/surgery , Urologic Surgical Procedures/methods , Urologists , Betacoronavirus , COVID-19 , Humans , Pandemics , Practice Patterns, Physicians' , SARS-CoV-2 , Societies, Medical , Surveys and Questionnaires , Triage , Urogenital Neoplasms/pathology
15.
J Robot Surg ; 14(6): 909-911, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-598631

ABSTRACT

Potential risks of COVID-19 spread during minimally invasive procedures caused several concerns among surgeons, despite the lack of high-level evidence. Urological robotic and laparoscopic surgery is performed in elective setting in almost all occasions, thus allowing adequate planning and stratification. Two high-volume urological centers in Italy performed 77 robotic and laparoscopic surgeries during the "lockdown" period and adopted various strategies to prevent contamination. First of all, all patients were tested negative with nasopharyngeal swab before the surgical intervention. Patients and personnel were provided adequate personal protective equipment and intraoperative strategies to prevent smoke formation and pneumoperitoneum spread were adopted. No patients nor staff members tested positive for COVID-19 during a 15-day follow-up period. In conclusion, minimally invasive urologic surgery can be safely performed during the pandemic period with adequate planning. We believe that renouncing the benefits of it would be counterproductive, especially in a scenario of long-lasting cohabitation with the virus.


Subject(s)
Coronavirus Infections/prevention & control , Infection Control/methods , Laparoscopy/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Female , Follow-Up Studies , Hospitals, High-Volume , Humans , Italy , Male , Middle Aged , Outcome Assessment, Health Care , Pneumonia, Viral/transmission , SARS-CoV-2
16.
Eur Urol Focus ; 6(5): 1070-1085, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-548747

ABSTRACT

CONTEXT: The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge. OBJECTIVE: To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic. EVIDENCE ACQUISITION: Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria. EVIDENCE SYNTHESIS: Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence). CONCLUSIONS: To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal. PATIENT SUMMARY: We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Standard of Care , Urologic Neoplasms/surgery , Urology/standards , Betacoronavirus , COVID-19 , Clinical Decision-Making , Endoscopy/methods , Humans , Laparoscopy/methods , Neoplasm Grading , Neoplasm Staging , Pandemics , Robotic Surgical Procedures/methods , SARS-CoV-2 , Urologic Diseases/surgery , Urologic Neoplasms/pathology , Urologic Surgical Procedures/methods
17.
J Laparoendosc Adv Surg Tech A ; 30(8): 915-918, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-528227

ABSTRACT

The COVID-19 outbreak has dramatically impacted our activities of pediatric surgeons and urologists over the past 3 months, especially in the field of minimally invasive surgery (MIS) and robotics. Analyzing the available literature, there is very scarce evidence regarding the use of MIS and robotics for treatment of pediatric surgical and urological pathologies during this pandemic. However, we found some useful information that we would like to share with other pediatric surgeons and urologists through this journal. Based upon the available data, we believe that surgery should only be performed in pediatric patients with emergent/urgent and oncological indications until resolution of the COVID-19 outbreak. Robotics and MIS may be safely performed in such selected children by adopting specific technical precautions such as prevention of aerosol dispersion using filters/suction or adapted systems and appropriate use of electrocautery and other sealing devices for reduction of surgical smoke, as reported in our recent experience. Another key point to manage this pandemic emergency is that all hospitals should provide health care professionals with adequate individual protections and perform universal screening in all patients undergoing surgery. Considering that this pandemic is a rapidly evolving situation with new information available daily, these data resulting from the analysis of literature focused on pediatric robotics and MIS may be further revised and updated.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Infection Control/methods , Minimally Invasive Surgical Procedures/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Robotic Surgical Procedures/methods , Urologic Surgical Procedures/methods , COVID-19 , Child , Humans , Pediatrics , SARS-CoV-2
18.
Prog Urol ; 30(8-9): 414-425, 2020.
Article in French | MEDLINE | ID: covidwho-304555

ABSTRACT

AIM: The management of urology patient is currently disrupted by the COVID-19 epidemic. In the field of functional urology, there are clinical situations with a high risk of complication if management is delayed and a great heterogeneity of advisable reprogramming times after cancellation. A prioritization of functional urology procedures is necessary to adapt management during the COVID-19 crisis and to better organize post-epidemic recovery. MATERIAL AND METHODS: The advice of AFU scientific committees in the field of functional urology (neuro-urology, female and perineology, male LUTS) was requested and supplemented by a review of the currently available recommendations on the subject of urology and COVID-19. These opinions were combined to draw up temporary recommendations to help reorganize practices during the epidemic and prepare the post-critical phase. RESULTS: Most of the recommendations available on career-oriented social networks (Twitter, LinkedIn) or in literature concern cancer or general urology. Eight out of ten propose a cancellation of all functional urology procedures without distinction. But the 3 AFU committees covering the field of functional urology have identified three clinical situations in which surgical procedures that can be maintained during the COVID-19 epidemic (priority level A): conclusion of a neuromodulation test in progress (implantation or explantation), botulinum toxin A bladder injections for unbalanced neurologic bladder, cystectomy and ileal conduit for urinary fistula in perineal bedsore or refractory unbalanced neurologic bladder with acute renal failure and vesico-enteric or prostato-pubic fistulas. Management adaptation of the other pathologies are proposed, as well as the application of 3 priority levels (B, C, D) for rescheduled procedures for a better management of the post-crisis activity resumption. CONCLUSION: The joint functional urology committees indicate that there are specific clinical situations in this field that demand non-delayed care during COVID crisis. They underline the need to establish a hierarchy for the cancelled surgeries, in order to reduce the arm of long reschedule delays and to optimize post-lockdown activity resumption.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Urologic Diseases/therapy , Urology/organization & administration , COVID-19 , Coronavirus Infections/prevention & control , Female , France/epidemiology , Humans , Male , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Urologic Surgical Procedures/methods
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