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1.
PLoS One ; 17(6): e0269827, 2022.
Article in English | MEDLINE | ID: covidwho-1892326

ABSTRACT

INTRODUCTION: Since the beginning of the pandemic in 2020, COVID-19 has changed the medical landscape. International recommendations for localized prostate cancer (PCa) include deferred treatment and adjusted therapeutic routines. MATERIALS AND METHODS: To longitudinally evaluate changes in PCa treatment strategies in urological and radiotherapy departments in Germany, a link to a survey was sent to 134 institutions covering two representative baseline weeks prior to the pandemic and 13 weeks from March 2020 to February 2021. The questionnaire captured the numbers of radical prostatectomies, prostate biopsies and case numbers for conventional and hypofractionation radiotherapy. The results were evaluated using descriptive analyses. RESULTS: A total of 35% of the questionnaires were completed. PCa therapy increased by 6% in 2020 compared to 2019. At baseline, a total of 69 radiotherapy series and 164 radical prostatectomies (RPs) were documented. The decrease to 60% during the first wave of COVID-19 particularly affected low-risk PCa. The recovery throughout the summer months was followed by a renewed reduction to 58% at the end of 2020. After a gradual decline to 61% until July 2020, the number of prostate biopsies remained stable (89% to 98%) during the second wave. The use of RP fluctuated after an initial decrease without apparent prioritization of risk groups. Conventional fractionation was used in 66% of patients, followed by moderate hypofractionation (30%) and ultrahypofractionation (4%). One limitation was a potential selection bias of the selected weeks and the low response rate. CONCLUSION: While the diagnosis and therapy of PCa were affected in both waves of the pandemic, the interim increase between the peaks led to a higher total number of patients in 2020 than in 2019. Recommendations regarding prioritization and fractionation routines were implemented heterogeneously, leaving unexplored potential for future pandemic challenges.


Subject(s)
COVID-19 , Prostatic Neoplasms , Humans , Male , Prostate/pathology , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/radiotherapy , Surveys and Questionnaires , Urologists
2.
Nat Rev Urol ; 19(6): 344-356, 2022 06.
Article in English | MEDLINE | ID: covidwho-1795727

ABSTRACT

On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.


Subject(s)
COVID-19 , Prostatic Neoplasms , Androgen Antagonists , Androgens , Humans , Male , Pandemics , Prostatic Neoplasms/epidemiology , SARS-CoV-2 , Urologists
3.
J Pediatr Urol ; 18(3): 335-339, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1739987

ABSTRACT

BACKGROUND/OBJECTIVE: This study aims to understand perspectives on routine pathological examination of hernia sacs following pediatric inguinal hernia and hydrocele repair among Canadian pediatric urologists, surgeons, and pathologists. STUDY DESIGN: All active members of Pediatric Urologists of Canada (PUC), Canadian Association of Pediatric Surgeons (CAPS), and the divisional heads of anatomical pathology at the Canadian children's hospitals (AP) were invited to participate between June 2019 and January 2021 in an anonymous multiple-choice-based questionnaire. RESULTS: The response rates were 71% from PUC (24/34), 20% from CAPS (25/130), and 64% from AP (7/11). The majority of the surgeons (PUC:54%, CAPS:68%) did not routinely send hernia sacs for pathological examination after inguinal hernia repair. Most felt there was a little value in such examination (PUC:96%, CAPS:72%). Among those who submit hernia sacs, the majority did not receive reports that were clinically significant impacting patient management (PUC:82%, CAPS:50%). On the other hand, the pathologists had mixed opinion on the value of examining hernia sacs. Most of them only did gross examination (86%), unless requested by surgeons or concerning features were noted on gross examination. The majority have found clinically meaningful abnormal findings (71%), including vas deferens and portions of the spermatic cord. DISCUSSION: Currently, there are no evidence-based clinical guidelines on pathological assessment of hernia sacs after pediatric inguinal hernia and hydrocele repair. Instead of making it mandatory, future guidelines should highlight specimens that should be submitted for further investigations (e.g., challenging cases where inadvertent surgical injuries might have occurred). Future studies should also address whether patients who may be at higher risk of having clinically significant pathology can be identified pre- or perioperatively to more efficiently triage specimens that would benefit from pathological examination. Limitation of the study includes low response rate from the CAPS members during the COVID-19 pandemic. CONCLUSIONS: While most of the pediatric urologists and surgeons felt there is a little value of pathological examination of hernia sacs following inguinal hernia and hydrocele repair, half of the anatomical pathologists felt there is value. Future studies should aim to establish evidence-based clinical guidelines taking stakeholders perspectives into consideration.


Subject(s)
COVID-19 , Hernia, Inguinal , Surgeons , Testicular Hydrocele , Canada/epidemiology , Child , Hernia, Inguinal/diagnosis , Hernia, Inguinal/surgery , Herniorrhaphy/adverse effects , Humans , Male , Pandemics , Pathologists , Testicular Hydrocele/diagnosis , Testicular Hydrocele/surgery , Urologists
4.
J Pediatr Urol ; 18(1): 17-22, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1457212

ABSTRACT

INTRODUCTION: Telemedicine has bridged the distance gap between patients and pediatric urologists for over a decade, yet many pediatric urologists have not embraced it as a major part of their practice. The purpose of this systematic review is to evaluate and clarify the optimal role of telemedicine in pediatric urology, as well as the benefits, barriers, risks, and other important considerations that must be accounted for in its optimal adoption. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review utilized Medical Subject Headings (MeSH) to search PubMed through April 29, 2021 as follows: (Humans [MeSH]) AND ((Child [MeSH]) OR (Infant [MeSH])) AND ((Remote Consultation [MAJR]) OR (Telemedicine [MAJR]) OR (Videoconferencing [MAJR]) OR (Health Services Accessibility [MAJR])) AND ((Urology [MAJR]) OR (Postoperative Care [MAJR]) OR (Urologic Surgical Procedures [MAJR])). 73 resulting articles, plus 21 from manual searches (e.g. papers too recent to have MeSH terms), were screened. 17 met inclusion criteria by discussing telemedicine in context of pediatric urology in a full manuscript. Non-complete manuscripts and papers not specifically considering pediatric urology, or in which telemedicine was not a major focus, were excluded. RESULTS: 17 papers met inclusion criteria. Varied approaches to the topic included surveys, controlled studies, retrospective studies, and descriptive opinion pieces. Quality of evidence varied, representing at least 1851 virtual encounters, 409 in-person encounters, and 68 clinician opinions. Four papers included a comparison or control group, and none utilized randomization. All 17 papers support expanded application of telemedicine in pediatric urology with varied evidence that telemedicine improves patient access to pediatric urologic care, satisfies both patient families and clinicians, is safe, provides equivalent outcomes, and is practicable. CONCLUSIONS: Implementation of telemedicine in pediatric urology should be expanded as it can practicably and safely improve patient access to pediatric urologic care, satisfy both patient families and clinicians, and maintain outcomes.


Subject(s)
Telemedicine , Urology , Child , Health Services Accessibility , Humans , Infant , Retrospective Studies , Urologists
5.
BJU Int ; 128(4): 425-427, 2021 10.
Article in English | MEDLINE | ID: covidwho-1455523

Subject(s)
Consultants , Urologists
8.
Urology ; 156: 289-295, 2021 10.
Article in English | MEDLINE | ID: covidwho-1246218

ABSTRACT

OBJECTIVE: To evaluate the urology providers' (through a range of training levels) experience utilizing telemedicine given the rapid nationwide implementation of telemedicine in urology practices due to COVID-19. Several studies focusing on the patient's perspective have illustrated that telemedicine is comparable to traditional office visits in terms of cost, communication, and overall satisfaction. However, there is sparse data on the provider's experience. METHODS: With IRB approval, we assessed provider satisfaction with telemedicine at Urology programs in the U.S. through an electronic survey. The 25-question survey was based on the Patient Assessment of Communication of Telehealth which is a validated 33 question instrument that has been utilized to assess the quality of patient-provider communication in telemedicine. Experience with telemedicine was assessed in 2 categories: technical aspects and communication with patients. Variables were rated using a 5-point Likert Scale. RESULTS: There were 144 responses to the survey. 50% of providers reported not receiving any formal training in using telemedicine. This differed significantly by training level with 55% of attendings having had received training vs 20% of residents. Providers felt they would most benefit from training in billing (52%) rather than equipment use (33%) or communication (28%). 87% of providers felt comfortable discussing sensitive topics while only 55% felt comfortable using telehealth to schedule surgery (P < .001). CONCLUSION: Urology providers are generally satisfied with their experience communicating with patients via telemedicine and the majority would opt to continue utilizing telemedicine. Nevertheless, many providers are hesitant to schedule surgery via telemedicine. Providers would benefit from formal training in telemedicine.


Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , Telemedicine , Urologists/education , Urology , Adult , Appointments and Schedules , Communication , Female , Humans , Internship and Residency/statistics & numerical data , Male , Middle Aged , Physician-Patient Relations , SARS-CoV-2 , Software , Surveys and Questionnaires , Urologic Surgical Procedures , Urologists/statistics & numerical data , Urology/organization & administration
10.
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
11.
J Pediatr Urol ; 17(4): 569-570, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1188820

ABSTRACT

COVID-19 began in December 2019 then spread worldwide. Providers, including pediatric urologists, had to adapt their clinical processes, and many non-covid research activities were suspended. COVID-19 impacts how research is financed, performed, and published, and is itself the subject of intense research. We present current research and publications specifically related to the urinary tract and the pediatric population.


Subject(s)
COVID-19 , Urology , Child , Humans , SARS-CoV-2 , Urologists
13.
Pan Afr Med J ; 37: 389, 2020.
Article in English | MEDLINE | ID: covidwho-1168164

ABSTRACT

INTRODUCTION: as COVID-19 pandemic is rapidly evolving, there is a whole reorganization in hospitals to concentrate more resources to face the crisis. The purpose of this study is to evaluate the impact of COVID-19 disease on urological activity in Tunisia. To assess the differences in the management of urological conditions between the private and the public field. METHODS: a survey was addressed to all certified urologists working in Tunisia in both the public and private sectors (n=194) using the national database of active urologists available and updated. We either called them or looked them up through email or social media. The form was open from March the 28th to April the 3rd. Results were obtained via spreadsheet and analysed using SPSS 23.0. RESULTS: one hundred and twenty urologists have filled in the form. Consultations at the outpatient office were restricted to urgent cases in 66% (n=79). Telemedicine was more used by urologists in private than in public fields p=0.03. Urologists in private sector followed more the sterilization protocol of the hospital/clinic and used more disposable materials whenever possible p=0.011. Elective surgical activity has completely stopped in 85% of the responders (n=102). Elective surgery requiring transfusion or intensive care unit was performed in 38% (n=46) and 26% (n=31) if there was a risk of disease progression. Benign Prostate Hyperplasia (BPH) surgery was more performed as usual in private sector than in public sector p=0.012. It was the only condition managed differently between both sectors. CONCLUSION: the drop of the urological activity is essential in order to give relevant stakeholders room to act efficiently against the spread of the virus. The context of the pandemic and the hospital´s condition must be taken into consideration without compromising the patient´s outcome.


Subject(s)
COVID-19 , Urologic Diseases/therapy , Urologic Surgical Procedures/statistics & numerical data , Urologists/statistics & numerical data , Adult , Elective Surgical Procedures/statistics & numerical data , Humans , Male , Middle Aged , Private Sector/statistics & numerical data , Prostatic Hyperplasia/surgery , Public Sector/statistics & numerical data , Surveys and Questionnaires , Telemedicine/statistics & numerical data , Tunisia , Urologic Diseases/physiopathology
14.
Urol Clin North Am ; 48(2): 161-171, 2021 May.
Article in English | MEDLINE | ID: covidwho-1129211

ABSTRACT

The future supply of urologists is not on pace to account for future demands of urologic care. This impending urologic shortage sits on a backdrop of multiple other workforce issues. In this review, we take an in-depth look at several pressing issues facing the urologic workforce, including the impending urology shortage, gender and diversity concerns, growing levels of burnout, and the effects of the coronavirus pandemic. In doing so, we highlight specific areas of clinical practice that may need to be addressed from a health care policy standpoint.


Subject(s)
Urologists/supply & distribution , Urology , Burnout, Professional/epidemiology , COVID-19/epidemiology , Female , Humans , Male , Pandemics , SARS-CoV-2 , United States/epidemiology
16.
Neurourol Urodyn ; 40(2): 695-704, 2021 02.
Article in English | MEDLINE | ID: covidwho-1046811

ABSTRACT

AIMS: To investigate the impact of COVID-19 pandemic on health-care provision to patients suffering from pelvic floor dysfunctions in Italy. METHODS: A retrospective web-based interdisciplinary survey was mailed by the Italian Society of Urodynamics to members involved in pelvic floor dysfunctions management from June 22, 2020 to July 17, 2020. The 84-item questionnaire investigated the period March-June 2020 (first epidemic wave) and showed high content validity. The primary outcome was the mean rate of cancellation for health-care services. Secondary outcomes included estimation of the accumulated surgeries backload until return to baseline activity and of the recovery pattern, using linear regression and scenario-based forecasting. RESULTS: A total of 85 participants provided complete responses. Respondents were mostly urologists (47%), followed by gynecologists (29.5%) and physiatrists (17.6%). On average, 78.4% of outpatient services and 82.7% of functional surgeries were canceled, without significant differences by geographical distribution. An impact on patients' quality of life was anticipated by most of the respondents (87%) and 48.2% also reported potentially serious health risks for patients. Thirty-three percent of the respondents reported the use of telemedicine. If the nation-wide surgical activity increases by 20% postpandemic, it would take 37 months to clear the backlog of functional surgeries. We acknowledge the inherent limitations of the survey methodology and retrospective design. CONCLUSIONS: Access to care for patients suffering from pelvic floor dysfunctions has been dramatically affected by the COVID-19 outbreak. The indirect effects of this unprecedented disruption on pelvic floor dysfunctions care may last for several months.


Subject(s)
Delivery of Health Care , Elective Surgical Procedures , Pelvic Floor Disorders/therapy , Time-to-Treatment , Adult , Ambulatory Care , COVID-19 , Female , Gynecologic Surgical Procedures , Gynecology , Humans , Italy , Male , Middle Aged , Pandemics , Pelvic Floor , Pelvic Organ Prolapse/surgery , Physiatrists , Prostatic Hyperplasia/surgery , Quality of Life , Rectal Diseases/surgery , Retrospective Studies , SARS-CoV-2 , Surveys and Questionnaires , Telemedicine , Urinary Incontinence, Stress/surgery , Urologic Surgical Procedures , Urologists , Workload
17.
Urologe A ; 59(12): 1492-1497, 2020 Dec.
Article in German | MEDLINE | ID: covidwho-1018220

ABSTRACT

Vaccines are one of the most effective weapons of humankind in the fight against various infectious diseases. Therefore, physicians from all specialties should not only regularly confirm their knowledge regarding vaccinations but also actively offer them in their daily routine. Urologists can use various vaccination offers to help protect their patients' future health. In addition to human papillomavirus (HPV) vaccinations for children and adolescents, this article shows how urologists who provide vaccines can fulfill their responsibility to implement the state vaccination recommendations to patients over the age of 60. Among others, HPV vaccination can have the effect of finally eradicating an evolutionary burden of humanity. In addition to standard vaccinations against tetanus, diphtheria and pertussis, special vaccinations also protect individuals over the age of 60 against pneumococci, influenza and herpes zoster. Moreover, urologists may in the future also save patients from COVID-19-the disease that actually made people aware of vaccinations again.


Subject(s)
COVID-19 , Papillomavirus Vaccines , Adolescent , Child , Humans , Pandemics , SARS-CoV-2 , Urologists , Vaccination
20.
J Med Internet Res ; 22(11): e21875, 2020 11 05.
Article in English | MEDLINE | ID: covidwho-945529

ABSTRACT

BACKGROUND: Prior to the COVID-19 pandemic, urology was one of the specialties with the lowest rates of telemedicine and videoconferencing use. Common barriers to the implementation of telemedicine included a lack of technological literacy, concerns with reimbursement, and resistance to changes in the workplace. In response to the COVID-19 pandemic declared in March 2020, the delivery of urological services globally has quickly shifted to telemedicine to account for the mass clinical, procedural, and operative cancellations, inadequate personal protective equipment, and shortage of personnel. OBJECTIVE: The aim of this study was to investigate current telemedicine usage by urologists, urologists' perceptions on the necessity of in-person clinic appointments, the usability of telemedicine, and the current barriers to its implementation. METHODS: We conducted a global, cross-sectional, web-based survey to investigate the use of telemedicine before and after the COVID-19 pandemic. Urologists' perceived usability of telemedicine was assessed using a modified Delphi approach to create questions based on a modified version of the validated Telehealth Usability Questionnaire (TUQ). For the purposes of this study, telemedicine was defined as video calls only. RESULTS: A total of 620 urologists from 58 different countries and 6 continents participated in the survey. Prior to COVID-19, 15.8% (n=98) of urologists surveyed were using telemedicine in their clinical practices; during the pandemic, that proportion increased to 46.1% (n=283). Of the urologists without telemedicine experience, interest in telemedicine usage increased from 43.7% (n=139) to 80.8% (n=257) during the COVID-19 pandemic. Among urologists that used telemedicine during the pandemic, 80.9% (n=244) were interested in continuing to use it in their practice. The three most commonly used platforms were Zoom, Doxy.me, and Epic, and the top three barriers to implementing telemedicine were patients' lack of technological comprehension, patients' lack of access to the required technology, and reimbursement concerns. CONCLUSIONS: This is the first study to quantify the use, usability, and pervading interest in telemedicine among urologists during the COVID-19 pandemic. In the face of this pandemic, urologists' usage of telemedicine nearly tripled, demonstrating their ability to adopt and adapt telemedicine into their practices, but barriers involving the technology itself are still preventing many from utilizing it despite increasing interest.


Subject(s)
COVID-19/epidemiology , Telemedicine/methods , Urologists/statistics & numerical data , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Surveys and Questionnaires
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