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Urologic Surgery and COVID-19: How the Pandemic Is Changing the Way We Operate.
Steward, James E; Kitley, Weston R; Schmidt, C Max; Sundaram, Chandru P.
  • Steward JE; Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Kitley WR; Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Schmidt CM; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  • Sundaram CP; Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
J Endourol ; 34(5): 541-549, 2020 05.
Article in English | MEDLINE | ID: covidwho-116341
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with COVID-19. Adequate personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For COVID-19 positive or suspected patients, the use of N95 respirators is recommended if available. The anesthesia method chosen should attempt to minimize aerosolization of the virus. Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures. COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Urologic Surgical Procedures / Infection Control / Coronavirus Infections / Disease Transmission, Infectious / Pandemics Type of study: Observational study / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: J Endourol Journal subject: Urology Year: 2020 Document Type: Article Affiliation country: End.2020.0342

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Urologic Surgical Procedures / Infection Control / Coronavirus Infections / Disease Transmission, Infectious / Pandemics Type of study: Observational study / Prognostic study Topics: Vaccines Limits: Humans Language: English Journal: J Endourol Journal subject: Urology Year: 2020 Document Type: Article Affiliation country: End.2020.0342