Urology in the Face of a Pandemic: The Impact of COVID-19 on the Delivery of Urological Care in a University Hospital

ABSTRACT

Introduction: COVID-19 has posed an unprecedented challenge to healthcare systems, via both its direct threat and a ripple effect on hospital services. Rapid emergence of COVID-era guidelines has ensued, suggesting a paradigm shift in surgical practice.1–3 We aimed to observe the impact on urological care delivery in an Irish university hospital. Methods: Data on urological activity was collected prospectively for 6 weeks from February 2020. A retrospective review of the same calendar period in 2019 was performed to obtain control data. Variables collected included admissions, elective/emergency cases, endoscopy/ESWL, nurse-led clinic and outpatient figures. Results: Over the 2020 study period, 118 urological admissions, including non-endoscopy day cases, were recorded, demonstrating 53.4% decrease from 2019 corresponding period (n = 253). A 51.2% decrease in flexible cystoscopies was seen (65 versus 133). 44 elective theatre cases (18 off-site at a private hospital) were performed in the 2020 period, compared to 63 in 2019. Major elective case numbers remained stable (n = 5). Laparoscopic work continued where surgically appropriate. In contrast to other figures, emergency case load increased by 180% to 54 cases in the 2020 period. Prospectively studied outpatient activity, compared to control period figures in brackets, involved 350(400) clinic consultations, 348(155) cancellations and 52(63) DNAs. 92 consultations were by virtual clinic. Conclusions: The early phase of the Irish COVID-19 outbreak has changed delivery of urological care. Nonetheless, emergency and urgent elective urological cases continue to present in similar numbers. The global challenge posed by COVID-19 will demand ongoing flexibility and resourcefulness to minimise the impact on patients with time-sensitive urological conditions.