El impacto de la pandemia del COVID-19 en la utilización de los servicios urológicos de urgencias / The impact of the COVID-19 pandemic on the utilization of emergency urological services

OBJETIVOS: Comparar el número de pacientes que acuden al Servicio de Urología del Centro Hospitalario Universitario de Oporto (CHUP), así como sus características demográficas, los motivos de ingreso, la gravedad clínica según el sistema de triaje de Manchester (MTS) y la necesidad de cirugía de urgencia u hospitalización, durante la pandemia y el período equivalente en 2019. MATERIAL Y MÉTODOS: Se recogieron datos de pacientes que acudieron al servicio de urgencias de Urología del CHUP durante tres semanas -del 11 de marzo de 2020 al 1 de abril de 2020 -y del mismo período del año anterior (del 11 de marzo al 1 de abril de 2019). Los resultados: Durante la pandemia, el número de visitas a nuestro servicio de urgencias de urología se redujo en un 46,4% (122 vs 263). No hubo diferencias considerables en la media de edad ni en el número de pacientes de la tercera edad (con 65 años o más) entre los dos períodos. Sin embargo, un número significativamente menor de pacientes femeninos acudió al servicio de urgencia durante el período de la pandemia COVID-19 (32,7% vs.14,8%, p < 0,05). No se observaron diferencias significativas entre los distintos grupos de gravedad clínica en el marco del MTS. En2019, un número significativamente menor de pacientes requirió hospitalización. Las razones más comunes de admisión, durante ambos períodos, fueron hematuria, cólico renal e infecciones del tracto urinario (ITU). Los autores reconocen que el estudio tienevarias limitaciones, a saber, las inherentes a su carácter retrospectivo. CONCLUSIÓN: COVID-19 influyó significativamente en la actitud al solicitar atención urológica. Con base en los resultados de este estudio, tenemos razones para especular que las necesidades de las personas en materia de servicios urológicos podrían crecer de forma explosiva en el período posterior a COVID-19. Se requieren más estudios sobre el estado real de los servicios urológicos a largo plazo y las consecuencias que esta pandemiapuede tener en términos de tasas morbilidad y mortalidad indirectamente relacionadas con el virus

OBJECTIVES: To compare the number of patients attending the Urology ED of Centro Hospitalar Universitário do Porto (CHUP), as well as their demographic characteristics, the reasons for admission, the clinical severity under the Manchester triage system (MTS), and the need for emergency surgery or hospitalization, during the pandemic and the equivalent period in 2019. MATERIAL AND METHODS: Data were collected from patients attending the Urology emergency ward of CHUP during three weeks -from March 11th 2020 to April 1st2020 -and from the same period the previous year (from March 11thto April 1st2019). RESULTS: During the pandemic, 46.4% fewer patients visited our urological ED (122 vs 263). There was no significant difference of the mean age or the number of old patients (with 65 or more years old) between the two periods. However, significantly fewer female patients sought emergency urological services during the COVID-19 pandemic period (32.7% vs.14.8%, p < 0.05). No significant differences were noted between different clinical severity groups under the MTS. In 2019, significantly less patients required hospitalization. The most common reasons for admission, during both periods, were hematuria, renal colic and urinary tract infections (UTI). The authors recognize that the study has several limitations, namely, those inherent to its retrospective nature. CONCLUSION: COVID-19 significantly influenced people's urological care-seeking behaviour. Based on the results of this study, we have reasons to speculate that people's requirements for urological services might grow explosively in the post-COVID-19 period. There should be further studies about the real state of long-term urological services and the consequences that this pandemic may have in terms of morbimortality not directly related to the virus

Which One Is the Best for Living Donation: A Multiple-Artery Left Kidney Nephrectomy or a Right Kidney Nephrectomy?

INTRODUCTION: The current approach in living-donor kidney transplant is to preserve the best kidney for the donor and harvest the contralateral one. Due to a shorter renal vein and a greater incidence of venous thrombosis, left kidneys are more frequently elected. Notwithstanding, arterial anatomy may be complex and thus render the transplantation procedure more difficult and prone to complications. OBJECTIVES: To analyze the outcomes after multiple-artery left kidney nephrectomy (MALKN) and right kidney nephrectomy (RKN). RESULTS: Seventy-three cases were performed from 1999 to 2017 in our institution: 34 MALKN and 39 RKN. The mean operative time was significantly longer in MALKN. Warm ischemia time, donor and receptor hospital stay, and postoperative complications did not differ between groups. There was a positive correlation between renal arteries' ostia distance in MALKN and the duration of warm ischemia period. There was no significant difference in the incidence of acute tubular necrosis, first-year variations in serum creatinine, and glomerular filtration rate between groups. Long-term graft survival did not significantly differ between groups. Three cases of vein thrombosis after RKN were reported with graft loss. CONCLUSION: The safety and efficacy of MALKN does not differ from RKN, although there appears to be a higher incidence of vein thrombosis after right kidney transplantation. Despite being technically more demanding, particularly in cases with distant artery ostia, MALKN could be a better option than RKN for living donation, expanding the available donor pool, although more studies are needed to affirm this conclusion.