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2.
ESMO Open ; 5(Suppl 3)2020 07.
Article in English | MEDLINE | ID: covidwho-646077

ABSTRACT

BACKGROUND: The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic. METHODS: We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19. FINDINGS: For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both. CONCLUSION: mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy.


Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Renal Cell/drug therapy , Coronavirus Infections/epidemiology , Kidney Neoplasms/drug therapy , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Betacoronavirus , Carcinoma, Renal Cell/secondary , Clinical Decision-Making , Coronavirus Infections/prevention & control , Humans , Immunologic Factors/therapeutic use , Kidney Neoplasms/pathology , Medical Oncology/statistics & numerical data , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Protein Kinase Inhibitors/therapeutic use , Urology/statistics & numerical data
5.
Int Braz J Urol ; 46(suppl.1): 156-164, 2020 07.
Article in English | MEDLINE | ID: covidwho-630552

ABSTRACT

PURPOSE: To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients. MATERIAL AND METHODS: A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care. RESULTS: Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively. CONCLUSIONS: At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urology/trends , Betacoronavirus , Hospitals/statistics & numerical data , Humans , Latin America , Pandemics , Surveys and Questionnaires , Urologic Surgical Procedures/statistics & numerical data
6.
BJU Int ; 125(6): 749, 2020 06.
Article in English | MEDLINE | ID: covidwho-623151
7.
Minerva Urol Nefrol ; 72(3): 376-383, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-616576

ABSTRACT

The public health emergency caused by the Coronavirus Disease 2019 (COVID-19) pandemic has resulted in a significant reallocation of health resources with a consequent reorganization of the clinical activities also in several urological centers. A panel of Italian urologists has agreed on a set of recommendations on pathways of pre-, intra- and post-operative care for urological patients undergoing urgent procedures or non-deferrable oncological interventions during the COVID-19 pandemic. Simplification of the diagnostic and staging pathway has to be prioritized in order to reduce hospital visits and consequently the risk of contagion. In absence of strict uniform regulations that impose the implementation of nasopharyngeal swabs, we recommend that an accurate triage for COVID-19 symptoms be performed both by telephone at home before hospitalization and at the time of hospitalization. We recommend that during hospital stay patients should be provided with as many instructions as possible to facilitate their return to, and stay at, home. Patients should be discharged under stable good conditions in order to minimize the risk of readmission. It is advisable to reduce or reschedule post-discharge controls and implement an adequate system of communication for telemonitoring discharged patients.


Subject(s)
Coronavirus Infections , Critical Pathways/statistics & numerical data , Pandemics , Pneumonia, Viral , Urologic Diseases/surgery , Urology , Elective Surgical Procedures , Female , Humans , Italy , Male , Perioperative Care , Public Health , Triage , Urologic Neoplasms/surgery , Urologic Surgical Procedures , Urologists
8.
Int Braz J Urol ; 46(suppl.1): 26-33, 2020 07.
Article in English | MEDLINE | ID: covidwho-611614

ABSTRACT

The COVID-19 pandemic has impacted our lives, our habits and our healthcare system. Italy is one of the countries affected first and more aggressively from the outbreak. Our rapidity has been guide for other healthcare systems from around the World. We describe the impact of COVID-19 on Urology, how the Urological scientific community responded to the emergency and our experience in a high-volume Roman University hospital. The aim of our work is to share our experience providing suggestions for other global hospitals on how to manage the COVID-19 emergency.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urology/trends , Betacoronavirus , Hospitals , Humans , Italy , Pandemics
9.
Int Braz J Urol ; 46(suppl.1): 93-97, 2020 07.
Article in English | MEDLINE | ID: covidwho-611613

ABSTRACT

This review discusses the impact of COVID-19 in Female Urology, revises the most important disorders in this field and how their diagnosis and treatment may be modified due to the current pandemic. The text also discusses new options such as telemedicine and what clinical situations within Female Urology should be of utmost importance for the urologist to be careful about. We also discuss how surgeries are being postponed are resumed according to the local scenario.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urology/trends , Betacoronavirus , Female , Female Urogenital Diseases , Humans , Pandemics , Telemedicine , Urology/methods
10.
Int Braz J Urol ; 46(suppl.1): 39-49, 2020 07.
Article in English | MEDLINE | ID: covidwho-611611

ABSTRACT

PURPOSE: To provide recommendations on the endourological management of lithiasis in the scenario of the COVID-19 pandemic. MATERIALS AND METHODS: A non-systematic review in PubMed and the grey literature, as well as recommendations by a panel of stakeholders was made, regarding management, surgical considerations and follow-up of patients affected by lithiasis in the COVID-19 era. RESULTS: Under the current outbreak and COVID-19 pandemic scenario, patients affected by lithiasis should be prioritized into low, intermediate and high risk categories, to decide their delay and save resources, healthcare personnel, beds and ventilators. However, patients with potentially serious septic complications need emergency interventions. The possibility of performing or restarting elective activity depends on local conditions, the availability of beds and ventilators, and the implementation of screening protocols in the context of the COVID-19 pandemic. Delaying lithiasis surgery and increasing waiting lists will have consequences and will require considerable additional effort. Teleconsultation may be useful in guiding these patients, reducing visits and unnecessary exposure. CONCLUSIONS: categorization and prioritization of patients affected by lithiasis is crucial for management, surgical selection and follow-up. Protocols, measures and additional efforts should be carried out in the current situation of the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Lithiasis/therapy , Pneumonia, Viral/epidemiology , Urology/methods , Betacoronavirus , Follow-Up Studies , Humans , Pandemics
11.
Int Braz J Urol ; 46(suppl.1): 34-38, 2020 07.
Article in English | MEDLINE | ID: covidwho-607469

ABSTRACT

The new disease COVID-19 pandemic has completely modified our lifestyle, changing our personal habits and daily activities and strongly our professional activity. Following World Health Organization (WHO) and health care authorities around the World recommendations, all elective surgeries from benign diagnose procedures must be postponed and imperatively continue working on emergent and oncological urgent pathologies. Surgical elective treatment of benign prostatic hyperplasia (BPH) is not considered as a priority. During BPH endoscopic surgeries, urine and blood are mixed with the irrigation liquid implying a risk of viral presence. Furthermore, a steam and smoke bubble is being accumulated inside the bladder implying the risk of splashing and aerosols. The risks of other viral infections have been identified during endourological procedures and they are related to splashing events. Several studies observed 33-100% of splashing on goggles. All BPH endoscopic procedures must be postponed. In case of complete urinary obstruction, this event can be adequately treated by urethral or suprapubic catheter under local anesthesia. As soon as local COVID-19 prevalence decreases, endourological procedures could be restarted. As protocols are being validating around the World to redeem elective surgeries, a symptomatic obstructed patient could be operated knowing his COVID-19 status with a molecular PCR, a cleaned epidemiological interview with a normal preoperative protocol. If patient is COVID-19+, surgery must be delayed until complete recovery, because mortality could increase as Lei from Wuhan describes. Informed consent must include risks of complications related to COVID-19 disease. Surgery must be performed by an experienced surgeon in order to avoid increase of operating time and risks of complications. Surgical approach of BPH must be considered depending on availability of disposable material, infrastructure, and the epidemiological COVID-19 status of your area. The main aim is patients and healthcare staff safety.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Prostatic Hyperplasia/therapy , Betacoronavirus , Elective Surgical Procedures , Humans , Infection Control , Male , Pandemics , Personal Protective Equipment , Urology/methods
12.
Curr Opin Urol ; 30(4): 610-616, 2020 07.
Article in English | MEDLINE | ID: covidwho-605599

ABSTRACT

PURPOSE OF REVIEW: The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption. RECENT FINDINGS: Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category. SUMMARY: Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.


Subject(s)
Coronavirus Infections/complications , Coronavirus , Pneumonia, Viral/complications , Urologists , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Urology
13.
Int Braz J Urol ; 46(suppl.1): 62-68, 2020 07.
Article in English | MEDLINE | ID: covidwho-602038

ABSTRACT

The COVID-19 outbreak has led to the deferral of a great number of surgeries in an attempt to reduce transmission of infection, free up hospital beds, intensive care and anaesthetists, and limit aerosol-generating procedures. Guidelines and suggestions have been provided to categorize Urological diseases into risk groups and recommendations are available on procedures that can be or cannot be deferred. We aim to summarise updates on diagnosis, treatment and follow up of bladder cancer during the COVID-19 outbreaks.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Urinary Bladder Neoplasms/diagnosis , Urinary Bladder Neoplasms/therapy , Betacoronavirus , Humans , Pandemics , Urology/methods
14.
Int Braz J Urol ; 46(suppl.1): 50-61, 2020 07.
Article in English | MEDLINE | ID: covidwho-601969

ABSTRACT

PURPOSE: Propose an approach of prostate cancer (PCa) patients during COVID-19 pandemic. MATERIAL AND METHODS: We conducted a review of current literature related to surgical and clinical management of patients during COVID-19 crisis paying special attention to oncological ones and especially those suffering from PCa. Based on these publications and current urological guidelines, a manual to manage PCa patients is suggested. RESULTS: Patients suffering from cancer are likely to develop serious complications from COVID-19 disease together with an increased risk of postoperative morbidity and mortality. Therefore, the management of oncological patients should be taken into special consideration and most of the treatments postponed. In case the procedure is not deferrable, it should be adapted to the current situation. While the shortest radiotherapy (RT) regimens should be applied, surgical procedures must undergo the following recommendations proposed by main surgical associations. PCa prognosis is generally favourable and therefore one can safely delay most of the biopsies up to 6 months without interfering with survival outcomes in the vast majority of cases. In the same way, most of the localised PCa patients are suitable for active surveillance (AS) or hormonal therapy until local definitive treatment could be reconsidered. In metastatic as well as castration resistant PCa stages, adding androgen receptor targeted agents (abiraterone, apalutamide, darolutamide or enzalutamide) to androgen-deprivation therapy (ADT) could be considered in high risk patients. On the contrary, chemotherapy, immunotherapy and Radium-223 must be avoided with regard to the consequence of hematologic toxicity and risk of COVID-19 infection because of immunodepression. CONCLUSIONS: Most of the biopsies should be delayed while AS is advised in those patients with low risk PCa. ADT allows us to defer definitive local treatment in many cases of intermediate and high risk PCa. In regard to metastatic and castration resistant PCa, combination therapies with abiraterone, apalutamide, darolutamide or enzalutamide could be considered. Chemotherapy, Radium-223 and immunotherapy are discouraged.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Prostatic Neoplasms/surgery , Prostatic Neoplasms/therapy , Urology/methods , Androgen Antagonists/therapeutic use , Betacoronavirus , Humans , Male , Pandemics
16.
Arch Ital Urol Androl ; 92(2)2020 Jun 23.
Article in English | MEDLINE | ID: covidwho-618551

ABSTRACT

COVID-19 pandemic strongly modified the organizations of our clinical practice. Strict containment measures have been adopted to limit the disease diffusion. In particular, hospital face-to-face post discharge and follow up visits have been reduced. Although cancelling or deferring appointments seems to be a pragmatic approach, this solution may have a devasting long-term impact on health medical care and on patients. In this context, telemedicine and remote consultations may have the potential to provide healthcare minimizing virus exposure. In this paper we describe how Multidisciplinary team (MDT) reorganized genitourinary cancer care delivery at our Institute (AO SS Antonio e Biagio e Cesare Arrigo, Alessandria), taking advantage of telematic means. Furthermore, we present our preliminary results regarding patients' satisfaction.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Patient Care Team , Pneumonia, Viral , Urogenital Neoplasms/therapy , Urology/methods , Aftercare/methods , Appointments and Schedules , Coronavirus Infections/prevention & control , Elective Surgical Procedures , Female , Humans , Male , Medicine , Office Visits , Oncology Nursing , Pandemics/prevention & control , Patient Satisfaction , Pneumonia, Viral/prevention & control , Telemedicine/methods , Telephone , Urogenital Neoplasms/psychology , Urogenital Neoplasms/surgery , Urologic Surgical Procedures
17.
Urol Oncol ; 38(7): 609-614, 2020 07.
Article in English | MEDLINE | ID: covidwho-436799

ABSTRACT

The Coronavirus Disease 2019 pandemic placed urologic surgeons, and especially urologic oncologists, in an unprecedented situation. Providers and healthcare systems were forced to rapidly create triage schemas in order to preserve resources and reduce potential viral transmission while continuing to provide care for patients. We reviewed United States and international triage proposals from professional societies, peer-reviewed publications, and publicly available institutional guidelines to identify common themes and critical differences. To date, there are varying levels of agreement on the optimal triaging of urologic oncology cases. As the need to preserve resources and prevent viral transmission grows, prioritizing only high priority surgical cases is paramount. A similar approach to prioritization will also be needed as nonemergent cases are allowed to proceed in the coming weeks. While these decisions will often be made on a case-by-case basis, more nuanced surgeon-driven consensus guidelines are needed for the near future.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/standards , Urologic Diseases/diagnosis , Urologic Surgical Procedures/standards , Clinical Decision-Making , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Humans , Medical Oncology/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , Societies, Medical/standards , Urologic Diseases/surgery , Urology/standards
18.
BJU Int ; 125(6): 749, 2020 06.
Article in English | MEDLINE | ID: covidwho-423318
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