Download PDF
CC BY 4.0 · Surg J (N Y) 2021; 07(01): e3-e10
DOI: 10.1055/s-0040-1722341
Review Article

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Bikash Bikram Thapa 
1   Department of Surgery, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
,
Dhan Shrestha 
2   Department of Emergency Medicine, Mangalbare Hospital, Morang, Nepal
,
Sanjeeb Bista
1   Department of Surgery, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
,
Suresh Thapa
1   Department of Surgery, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
,
Vikram Niranjan
3   Health Research Institute/Graduate Entry Medical School, University of Limerick, Limerick, Ireland
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background Coronavirus disease 2019 (COVID-19) has evolved as a pandemic of unimaginable magnitude. The health care system is facing a tremendous challenge to provide ethical and quality care. The transformation of the patient-based care to population-based care during the COVID-19 pandemic has raised ethical dilemma among urologists. Our objective is to explore the consensus in modified standard urology care, that can be adopted and applied during COVID-19 and similar pandemic.

Methods We adopted an exploratory study design using secondary data. The data were extracted from a web-based medical library using keywords “COVID-19,” “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” and “urology.” We identify and extrapolate (screening, eligibility, and inclusion) the data using PRISMA protocol, and summarize pandemic standard urology care under four main themes: (1) general urology care, (2) choice of surgical modality, (3) triage, and (4) urology training.

Result We identified 63 academic papers related to our research question. The majority are expert opinions and perspectives on urology care. The common consensus is triage-based urology care and surgeries. Life or organ threatening conditions need immediate attention. Universal protective measures (personal protective equipment, safe operative environment) and protocol-based patient care are necessary to prevent and control SARS-CoV-2 infection. Conservation of the resources and its rational distribution provide an ethical basis for population-based health care during a pandemic. Informed decision making serves best to patients, families, and society during the public health crisis.

Conclusion COVID-19 pandemic tends to transform standard urology practice into crisis standard population-based care. The consensus in crisis is drawn from evolving pieces of medical evidence and public health ethics. The provision of urology care during a pandemic is based on the availability of resources; severity of the disease, consequences of deferment of service, and dynamics of the pandemic.

Keywords

COVID-19 - infection - pandemic - urology - standard urology care

Authorship Contributions

Authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results.


Disclaimer

There is no funding sources and no conflict of interest. This review is original work of the authors listed.




Publication History

Received: 20 July 2020

Accepted: 14 October 2020

Article published online:
15 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020 . Accessed June 23, 2020 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports
    PubMedGoogle Scholar
  • 2 Kramer JB, Brown DE, Kopar PK. Ethics in the time of coronavirus: Recommendations in the COVID-19 pandemic. J Am Coll Surg 2020; 230 (06) 1114-1118
    CrossrefPubMedGoogle Scholar
  • 3 Iserson KV. Healthcare ethics during a pandemic. West J Emerg Med 2020; 21 (03) 477-483
    CrossrefPubMedGoogle Scholar
  • 4 Morlacco A, Motterle G, Zattoni F. The multifaceted long-term effects of the COVID-19 pandemic on urology. Nat Rev Urol 2020; 17 (07) 365-367
    CrossrefPubMedGoogle Scholar
  • 5 Ahmed K, Hayat S, Dasgupta P. Global challenges to urology practice during the COVID-19 pandemic. BJU Int 2020; 125 (06) E5-E6
    CrossrefPubMedGoogle Scholar
  • 6 Naspro R, Da Pozzo LF. Urology in the time of corona. Nat Rev Urol 2020; 17 (05) 251-253
    CrossrefPubMedGoogle Scholar
  • 7 Brindle ME, Gawande A. Managing COVID-19 in surgical systems. Ann Surg 2020; 272 (01) e1-e2
    CrossrefPubMedGoogle Scholar
  • 8 Ademuyiwa AO, Bekele A, Berhea AB. et al. COVID-19 preparedness within the surgical, obstetric, and anesthetic ecosystem in Sub-Saharan Africa. Ann Surg 2020; 272 (01) e9-e13
    CrossrefPubMedGoogle Scholar
  • 9 Ng ASH, Chew MH, Charn TC, Wong MK, Wong WK, Lee LS. Keeping a cut above the coronavirus disease: surgical perspectives from a public health institution in Singapore during Covid-19. ANZ J Surg 2020; 90 (05) 666-669
    CrossrefPubMedGoogle Scholar
  • 10 Carneiro A, Wroclawski ML, Nahar B. et al. Impact of the COVID-19 pandemic on the urologist's clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period. Int Braz J Urol 2020; 46 (04) 501-510
    CrossrefPubMedGoogle Scholar
  • 11 Ho HC, Hughes T, Bozlu M, Kadıoğlu A, Somani BK. What do urologists need to know: diagnosis, treatment, and follow-up during COVID-19 pandemic. Turk J Urol 2020; 46 (03) 169-177
    CrossrefPubMedGoogle Scholar
  • 12 Ellis R, Hay-David AGC, Brennan PA. Operating during the COVID-19 pandemic: how to reduce medical error. Br J Oral Maxillofac Surg 2020; 58 (05) 577-580
    CrossrefPubMedGoogle Scholar
  • 13 Maida FD, Antonelli A, Porreca A, Rocco B, Mari A, Minervini A. Letter to the Editor: “Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection”. EClinicalMedicine 2020; 22: 100362
    CrossrefPubMedGoogle Scholar
  • 14 Steward JE, Kitley WR, Schmidt CM, Sundaram CP. Urologic surgery and COVID-19: how the pandemic is changing the way we operate. J Endourol 2020; 34 (05) 541-549
    CrossrefPubMedGoogle Scholar
  • 15 Puliatti S, Eissa A, Eissa R. et al. COVID-19 and urology: a comprehensive review of the literature. BJU Int 2020; 125 (06) E7-E14
    CrossrefPubMedGoogle Scholar
  • 16 Stensland KD, Morgan TM, Moinzadeh A. et al. Considerations in the triage of urologic surgeries during the COVID-19 pandemic. Eur Urol 2020; 77 (06) 663-666
    CrossrefPubMedGoogle Scholar
  • 17 Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: an evidence-based approach for optimization of infection control and operating room management. Anesth Analg 2020; 131 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 18 Society of American Gastrointestinal and Endoscopic Surgeons S. Management of endoscopes, endoscope reprocessing, and storage areas during the COVID-19 pandemic. Sages webmaster. Disinfection, Handling, and Endoscope Storage Web site. Published in 2020. Accessed June 23, 2020 at: https://www.sages.org/management-endoscopes-reprocessing-storage-covid-19/
    PubMedGoogle Scholar
  • 19 Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg 2020; 272 (01) e5-e6
    CrossrefPubMedGoogle Scholar
  • 20 Novara G, Giannarini G, De Nunzio C, Porpiglia F, Ficarra V. Risk of SARS-CoV-2 diffusion when performing minimally invasive surgery during the COVID-19 pandemic. Eur Urol 2020; 78 (01) e12-e13
    CrossrefPubMedGoogle Scholar
  • 21 SAGES. SAGES and EAES recommendation regarding surgical response to COVID-19 crisis. Society of American Gastrointestinal and Endoscopic Surgeons. Published in 2020. Accessed on June 23, 2020 at: https://www.sages.org/recommendations-surgical-response-covid-19/
    PubMedGoogle Scholar
  • 22 Narain TA, Gautam G, Seth A. et al. Uro-oncology in times of COVID-19: the available evidence and recommendations in the Indian scenario. Indian J Cancer 2020; 57 (02) 129-138
    PubMedGoogle Scholar
  • 23 Goldman HB, Haber GP. Recommendations for tiered stratification of urological surgery urgency in the COVID-19 era. J Urol 2020; 204 (01) 11-13
    CrossrefPubMedGoogle Scholar
  • 24 Quaedackers JSLT, Stein R, Bhatt N. et al. Clinical and surgical consequences of the COVID-19 pandemic for patients with pediatric urological problems: statement of the EAU guidelines panel for paediatric urology, March 30, 2020. J Pediatr Urol 2020; 16 (03) 284-287
    CrossrefPubMedGoogle Scholar
  • 25 Boehm K, Ziewers S, Brandt MP. et al. Telemedicine online visits in urology during the COVID-19 pandemic-potential, risk factors, and patients' perspective. Eur Urol 2020; 78 (01) 16-20
    CrossrefPubMedGoogle Scholar
  • 26 Connor MJ, Winkler M, Miah S. COVID-19 pandemic—is virtual urology clinic the answer to keeping the cancer pathway moving?. BJU Int 2020; 125 (06) E3-E4
    CrossrefPubMedGoogle Scholar
  • 27 Gillessen S, Powles T. Advice regarding systemic therapy in patients with urological cancers during the COVID-19 pandemic. Eur Urol 2020; 77 (06) 667-668
    CrossrefPubMedGoogle Scholar
  • 28 Teoh JYC, Roupret M, Shariat SF, Herrmann T. Intravesical therapy for bladder cancer in the pandemic of COVID-19. World J Urol 2020; (e-pub ahead of print) DOI: 10.1007/s00345-020-03218-8.
    CrossrefPubMedGoogle Scholar
  • 29 Ficarra V, Novara G, Abrate A. et al; Research Urology Network (RUN). Urology practice during the COVID-19 pandemic. Minerva Urol Nefrol 2020; 72 (03) 369-375
    CrossrefPubMedGoogle Scholar
  • 30 Tefik T, Guven S, Villa L. et al. Urolithiasis practice patterns following the COVID-19 pandemic: overview from the EULIS Collaborative Research Working Group. Eur Urol 2020; 78 (01) e21-e24
    CrossrefPubMedGoogle Scholar
  • 31 Campi R, Amparore D, Capitanio U. et al. Assessing the burden of nondeferrable major uro-oncologic surgery to guide prioritisation strategies during the COVID-19 pandemic: insights from three Italian high-volume referral centres. Eur Urol 2020; 78 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 32 Hegarty PK, Sfakianos JP, Giannarini G, DiNardo AR, Kamat AM. COVID-19 and Bacillus Calmette-Guerin: What is the Link?. Eur Urol Oncol 2020; 3 (03) 259-261
    CrossrefPubMedGoogle Scholar
  • 33 Rizzo M, Liguori G, Verze P, Palumbo F, Cai T, Palmieri A. How the andrological sector suffered from the dramatic COVID 19 outbreak in Italy: supportive initiatives of the Italian Association of Andrology (SIA). Int J Impot Res 2020; 32 (05) 547-548
    CrossrefPubMedGoogle Scholar
  • 34 Cocci A, Presicce F, Russo GI, Cacciamani G, Cimino S, Minervini A. How sexual medicine is facing the outbreak of COVID-19: experience of Italian urological community and future perspectives. Int J Impot Res 2020; 32 (05) 480-482
    CrossrefPubMedGoogle Scholar
  • 35 Liu X, Chen Y, Tang W. et al. Single-cell transcriptome analysis of the novel coronavirus (SARS-CoV-2) associated gene ACE2 expression in normal and non-obstructive azoospermia (NOA) human male testes. Sci China Life Sci 2020; 63 (07) 1006-1015
    CrossrefPubMedGoogle Scholar
  • 36 Witherspoon L, Fitzpatrick R, Patel P. et al. Clinical pearls to managing men's health conditions during the COVID-19 pandemic. Can Urol Assoc J 2020; 14 (05) E161-E166
    CrossrefPubMedGoogle Scholar
  • 37 Esteves SC, Lombardo F, Garrido N. et al. SARS-CoV-2 pandemic and repercussions for male infertility patients: a proposal for the individualized provision of andrological services. Andrology 2020; (e-pub ahead of print) DOI: 10.1111/andr.12809.
    CrossrefPubMedGoogle Scholar
  • 38 Ho QY, Chung SJ, Gan VHL, Ng LG, Tan BH, Kee TYS. High-immunological risk living donor renal transplant during the COVID-19 outbreak: uncertainties and ethical dilemmas. Am J Transplant 2020; 20 (07) 1949-1951
    CrossrefPubMedGoogle Scholar
  • 39 Ritschl PV, Nevermann N, Wiering L. et al. Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: a by-proxy society recommendation consensus approach. Am J Transplant 2020; 20 (07) 1826-1836
    CrossrefPubMedGoogle Scholar
  • 40 Porpiglia F, Checcucci E, Amparore D. et al. Slowdown of urology residents' learning curve during the COVID-19 emergency. BJU Int 2020; 125 (06) E15-E17
    CrossrefPubMedGoogle Scholar
  • 41 Porpiglia F, Checcucci E, Autorino R. et al. Traditional and virtual congress meetings during the COVID-19 pandemic and the post-COVID-19 era: is it time to change the paradigm?. Eur Urol 2020; 78 (03) 301-303
    CrossrefPubMedGoogle Scholar
  • 42 Nassar AH, Zern NK, McIntyre LK. et al. Emergency restructuring of a general surgery residency program during the coronavirus disease 2019 pandemic: the University of Washington Experience. JAMA Surg 2020; 155 (07) 624-627
    CrossrefPubMedGoogle Scholar
  • 43 Kwon YS, Tabakin AL, Patel HV. et al. Adapting urology residency training in the COVID-19 era. Urology 2020; 141: 15-19
    CrossrefPubMedGoogle Scholar
  • 44 Abdessater M, Rouprêt M, Misrai V. et al; Association Française des Urologues en Formation (AFUF). COVID19 pandemic impacts on anxiety of French urologist in training: outcomes from a national survey. Prog Urol 2020; 30 (8-9): 448-455
    CrossrefPubMedGoogle Scholar
  • 45 Ribal MJ, Cornford P, Briganti A. et al. European Association of Urology Guidelines Office Rapid Reaction Group: An organisation-wide collaborative effort to adapt the European Association Of Urology Guidelines recommendations to the Coronavirus Disease 2019 Era. Eur Urol 2020; 78 (01) 21-28
    CrossrefPubMedGoogle Scholar
  • 46 COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; 396 (10243): 27-38
    CrossrefPubMedGoogle Scholar
  • 47 Ling Y, Xu SB, Lin YX. et al. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J (Engl) 2020; 133 (09) 1039-1043
    CrossrefPubMedGoogle Scholar
  • 48 Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology 2020; 158 (06) 1518-1519
    CrossrefPubMedGoogle Scholar
  • 49 Desouky E. BCG versus COVID-19: impact on urology. World J Urol 2020; (e-pub ahead of print) DOI: 10.1007/s00345-020-03251-7.
    CrossrefPubMedGoogle Scholar
  • 50 Cini C, Bortot G, Sforza S. et al. Paediatric urology practice during COVID-19 pandemic. J Pediatr Urol 2020; 16 (03) 295-296
    CrossrefPubMedGoogle Scholar
  • 51 Gadzinski AJ, Ellimoottil C. Telehealth in urology after the COVID-19 pandemic. Nat Rev Urol 2020; 17 (07) 363-364
    CrossrefPubMedGoogle Scholar
  • 52 Simonato A, Giannarini G, Abrate A. et al; Research Urology Network (RUN). Clinical pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol 2020; 72 (03) 376-383
    CrossrefPubMedGoogle Scholar
  • 53 Valenza F, Papagni G, Marchianò A. et al. Response of a comprehensive cancer center to the COVID-19 pandemic: the experience of the Fondazione IRCCS-Istituto Nazionale dei Tumori di Milano. Tumori 2020; (e-pub ahead of print) DOI: 10.1177/0300891620953471.
    CrossrefPubMedGoogle Scholar