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Di Maida F, Grosso AA, Lambertini L, Paganelli D, Marzocco A, Salamone V, Bacchiani M, Oriti R, Vittori G, Salvi M, Tuccio A, Mari A, Minervini A. Is it safe to defer prostate cancer treatment? Assessing the impact of surgical delay on the risk of pathological upstaging after robot-assisted radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108398. [PMID: 38733924 DOI: 10.1016/j.ejso.2024.108398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/28/2024] [Accepted: 05/07/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION We sought to investigate whether surgical delay may be associated with pathological upstaging in patients treated with robot assisted radical prostatectomy (RARP) for localized and locally advanced prostate cancer (PCa). MATERIALS AND METHODS Consecutive firstly-diagnosed PCa patients starting from March 2020 have been enrolled. All the patients were categorized according to EAU risk categories for PCa risk. Uni- and multivariate analysis were fitted to explore clinical and surgical predictors of pathological upstaging to locally advanced disease (pT3/pT4 - pN1 disease). RESULTS Overall 2017 patients entered the study. Median age at surgery was 68 (IQR 63-73) years. Overall low risk, intermediate risk, localized high risk and locally advanced disease were recorded in 368 (18.2 %), 1071 (53.1 %), 388 (19.2 %) and 190 (9.4 %), respectively. Median time from to diagnosis to treatment was 51 (IQR 29-70) days. Time to surgery was 56 (IQR 32-75), 52 (IQR 30-70), 45 (IQR 24-60) and 41 (IQR 22-57) days for localized low, intermediate and high risk and locally advanced disease, respectively. Considering 1827 patients with localized PCa, at multivariate analysis ISUP grade group ≥4 on prostate biopsy (HR: 1.30; 95 % CI 1.07-1.86; p = 0.02) and surgical delay only in localized high-risk disease (HR: 1.02; 95 % CI 1.01-1.54; p = 0.02) were confirmed as independent predictors of pathological upstaging to pT3-T4/pN1 disease at final histopathological examination. CONCLUSIONS In localized high-risk disease surgical delay could be associated with a higher risk of adverse pathologic findings.
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Affiliation(s)
- Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Luca Lambertini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Daniele Paganelli
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Marzocco
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Vincenzo Salamone
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Mara Bacchiani
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Rino Oriti
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Gianni Vittori
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Matteo Salvi
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence - Unit of Oncologic Minimally Invasive Urology and Andrology, Careggi Hospital, Florence, Italy.
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Whiles BB, Reich DA, Green J, Yu F, Bird VG. Evaluation of fear, willingness to seek care, and healthcare delivery preferences for patients with nephrolithiasis during the COVID-19 pandemic. Transl Androl Urol 2024; 13:962-969. [PMID: 38983481 PMCID: PMC11228673 DOI: 10.21037/tau-23-627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 07/11/2024] Open
Abstract
Background Although minimal is known about coronavirus disease 2019 (COVID-19)'s impact on patient healthcare perceptions, improved understanding can guide healthcare providers to adequately address patient concerns. This cross-sectional study investigated how fear induced by COVID-19 impacted nephrolithiasis patients' perceptions, decision-making, and preferences for care delivery. Methods Utilizing the validated Fear of COVID-19 Scale (FCV-19S), patients were surveyed at a single stone clinic during part of the COVID-19 pandemic, 03/2021-04/2022. One-way analysis of variance (ANOVA), Chi-square tests, and multinomial logistic regression evaluated the effect of sociodemographics on responses. Results Two hundred and four surveys were completed. Mean age was 58±16 years, and 112 (54.9%) were women. Mean FCV-19S was 14.8±5.8 points (range, 7-33). Women and non-Caucasian races were associated with higher fear scores (P<0.01 and P=0.01 respectively). Stone prevention effort was not associated with fear (P=0.38). Poorer self-assessed health status was associated with increased stone prevention efforts (P=0.04). Preference for in-person care was reported in 89% of patients. Willingness to seek care varied by age and education, with decreased likelihood to seek care for middle-aged patients (P=0.04) and increased education (P=0.01). Conclusions Perceived fear during the COVID-19 pandemic was highly variable in nephrolithiasis patients, with higher fear scores in women and non-Caucasians. Willingness to seek care during the pandemic varied with age, education level, symptom severity, COVID-19 fear, current stone status, and health status. Stone patients greatly preferred in-person medical care over telemedicine during COVID-19. Future studies are needed to further evaluate these health disparities, discrepancies in fear, and comfort in seeking stone-related healthcare to help us better inform health policymakers and provide patient-centered care.
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Affiliation(s)
| | - Daniel A. Reich
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Jacob Green
- Department of Urology, University of Florida, Gainesville, FL, USA
- University of Florida, Gainesville, FL, USA
| | - Fahong Yu
- Interdisciplinary Center for Biotechnology Research, University of Florida, Gainesville, FL, USA
| | - Vincent G. Bird
- Department of Urology, University of Florida, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
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Egen L, Wessels F, Quan A, Westhoff N, Kriegmair MC, Honeck P, Michel MS, Kowalewski KF. Maximizing efficiency and ensuring safety: Exploring the outcomes of 2 consecutive open radical cystectomies by the same team within a single surgical day. Urol Oncol 2024; 42:118.e1-118.e7. [PMID: 38246807 DOI: 10.1016/j.urolonc.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes of performing 2 consecutive open radical cystectomies (RCs) within 1 day by the same surgical team. PATIENTS AND METHODS A retrospective analysis was conducted on data from patients who underwent RC at a single tertiary care center from January 2015 to February 2023. Patient characteristics, perioperative outcomes and endpoints were analyzed. Univariable and multivariable logistic regression models were created to predict major complications. RESULTS A total of 657 patients were included in the final cohort, containing 64 paired RCs (32 RC1 and 32 RC2) and 593 single RCs. Major complications occurred in 24.7% of the entire cohort, with no significant differences between single RC vs. RC1 and RC2. Paired RCs showed significantly shorter operative time (OT; p = 0.001) and length of stay (LOS; p = 0.047) compared to single RCs. There were no significant differences in transfusion rates, 30-day readmission, 30-day mortality, or histopathological results between paired and single RCs. Multivariable analysis identified patient characteristics such as age (OR = 1.67, p = 0.03), sex (OR = 0.45, p = 0.008), BMI (OR = 1.98, p = 0.007), ASA-score (OR = 1.61, p = 0.04), and OT (OR = 1.87, p = 0.008) as independent predictors of major complications. CONCLUSION Performing 2 consecutive open RCs within 1 day by the same surgical team is a safe approach in experienced hands. This strategy optimizes the utilization of surgical resources and addresses the growing demand for urologic care while maintaining high-quality patient care. Preoperative planning should consider patient-specific factors to minimize risks associated with major complications. MICRO ABSTRACT This study evaluates the outcomes of performing 2 consecutive open radical cystectomies (RC) in a single day by the same surgical team. Data from 657 patients who underwent RC at a single tertiary medical center proved that this approach is safe, with no significant differences in major complications. Preoperative planning should consider patient-specific factors for efficient utilization of surgical resources.
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Affiliation(s)
- Luisa Egen
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany; German Cancer Research Center (DKFZ) Heidelberg, Division of Intelligent Systems and Robotics in Urology (ISRU), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany.
| | - Frederik Wessels
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Allison Quan
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | - Niklas Westhoff
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | | | - Patrick Honeck
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany
| | | | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Center Mannheim, Mannheim, Germany; German Cancer Research Center (DKFZ) Heidelberg, Division of Intelligent Systems and Robotics in Urology (ISRU), Heidelberg, Germany; DKFZ Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany
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Siron N, Assad A, Ouirzanne M, Lafontaine ML, Zorn KC, Lattouf JB, Meskawi M, Duceppe E, Bhojani N. Performing urological inpatient procedures as same-day procedures during the COVID pandemic A retrospective feasibility study. Can Urol Assoc J 2023; 17:E319-E329. [PMID: 37494314 PMCID: PMC10581737 DOI: 10.5489/cuaj.8324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
INTRODUCTION In line with Canadian provincial directives due to the COVID-19 pandemic, certain elective urologic surgical cases that are normally performed as inpatient procedures were performed as same-day discharge procedures to reduce hospitalization and the usage of scarce healthcare resources. Since the pandemic, we began performing laser enucleation of the prostate (LEP), robotic-assisted radical prostatectomy (RARP), and percutaneous nephrolithotomy (PCNL ) as outpatient surgeries. This was supported by recent evidence demonstrating the safety and feasibility of performing these minimally invasive surgeries as same-day procedures. As such, we sought to retrospectively evaluate the clinical outcomes and safety during the COVID-19 era at our institution for same-day discharge LEP, RARP, and PCNL procedures. METHODS All patients operated for LEP, RARP, or PCNL between May 2020 and March 2022 at two academic institutions were included. Surgeries were classified as planned same-day discharge or inpatient surgery. Same-day discharge patients were compared to inpatients for each procedure type. This comparison assessed the occurrence of same-day failure, postoperative complications, and re-admission rates at 30 days. This study was approved by the scientific ethics committee of the Centre de Recherche de l'Université de Montréal (CRCHUM). RESULTS A total of 413 subjects were included in this study. Among LEP patients (n=169), 104 (62%) were identified as same-day procedures and 65 (38%) were inpatient. Among RARP patients (n=194), 46 (24%) were identified as same-day procedures and 148 (76%) inpatient. Among PCNL patients (n=50), 38 (76%) were identified as same-day procedures and 12 (24%) were inpatient. Of the patients who underwent planned same-day LEP, RARP, and PCNL, 77.9%, 73.9%, and 71.1% were successfully discharged home, respectively. Patients who underwent LEP as inpatients had a higher incidence of overall postoperative complications compared to same-day LEP (23.1% vs. 8.7%, p=0.017). The rates of 30-day emergency department (ED ) visits and hospital re-admission were similar between inpatient and same-day LEP (9.2% vs. 3.8%, p=0.27; and 4.6% vs. 1.0%, p=0.32, respectively). Inpatient RARP, however, was associated with more 30-day ED visits compared to same-day procedures (17.4% vs. 4.1%, p<0.01). No statistically significant differences were found for postoperative complications (15.2% vs. 6.1%, p=0.097) and re-admission rates (1.4% vs. 4.3%, p=0.51). There were no significant differences on overall postoperative complications, 30-day ED visits, and re-admission rates in inpatient vs. same-day PCNL. CONCLUSIONS Our results suggest that same-day discharge for LEP, RARP, and PCNL is safe and feasible in select patients, with an acceptable complication rate. These results should be validated in a larger, prospective clinical trial comparing same-day and inpatient procedures.
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Affiliation(s)
- Nicolas Siron
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Anis Assad
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Mona Ouirzanne
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Marie-Lyssa Lafontaine
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Kevin C. Zorn
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Jean-Baptiste Lattouf
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Malek Meskawi
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Division of Urology, Hôpital Sacré-Coeur de Montréal, Montreal, QC, Canada
| | - Emmanuelle Duceppe
- Division of Internal Medicine, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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Rodler S, Bujoreanu CE, Baekelandt L, Volpi G, Puliatti S, Kowalewski KF, Belenchon IR, Taratkin M, Rivas JG, Veccia A, Piazza P, Carrion DM, Cacciamani GE, Esperto F, Checcucci E. The Impact on Urology Residents' Learning of Social Media and Web Technologies after the Pandemic: A Step Forward through the Sharing of Knowledge. Healthcare (Basel) 2023; 11:1844. [PMID: 37444678 DOI: 10.3390/healthcare11131844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The COVID-19 pandemic has impacted urology residents and their training. However, several new technologies or knowledge platforms as social media (SoMe) and web-based learning solutions have filled this gap. Therefore, we aimed to analyze resident's learning curves of new learning modalities, identify the evidence that is provided in the literature, and evaluate the possible impact of such solutions in the future. We conducted a non-systematic literature search using Medline, PubMed, and Embase. In addition, online resources of national and international urology resident societies were queried. The identified paper described SoMe, webinars, podcasts, pre-recorded surgical videos, educational platforms, and mobile apps in the field of urology that are used to gain access to information, teach and provide feedback to residents, and were used under the conditions of the pandemic. The application of those technologies harbors the risk of mis- and disinformation, but have the potential to provide access to education and validated knowledge, training, and feedback and thereby might democratize training of residents in urology globally.
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Affiliation(s)
- Severin Rodler
- Department of Urology, LMU University Hospital, LMU Munich, 81377 Munich, Germany
| | | | - Loic Baekelandt
- Department of Urology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Gabriele Volpi
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy
| | - Stefano Puliatti
- Department of Urology, University of Modena and Reggio Emilia, 42121 Modena, Italy
| | - Karl-Friedrich Kowalewski
- Department of Urology, University Medical Center Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Ines Rivero Belenchon
- Urology and Nephrology Department, Virgen del Rocío University Hospital, Manuel Siurot s/n, 41013 Seville, Spain
| | - Mark Taratkin
- Institute for Urology and Reproductive Health, Sechenov University, 119435 Moscow, Russia
| | - Juan Gomez Rivas
- Department of Urology, Hospital Clinico San Carlos, 28040 Madrid, Spain
| | - Alessandro Veccia
- Urology Unit, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Diego M Carrion
- Department of Urology, Torrejon University Hospital, 28850 Madrid, Spain
- Department of Urology, Universidad Francisco de Votoria, 28223 Madrid, Spain
| | | | - Francesco Esperto
- Department of Urology, Campus Biomedico, University of Rome, 00128 Rome, Italy
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, 10060 Turin, Italy
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Le Bihan-Benjamin C, Rocchi M, Putton M, Méric JB, Bousquet PJ. Estimation of Oncologic Surgery Case Volume Before and After the COVID-19 Pandemic in France. JAMA Netw Open 2023; 6:e2253204. [PMID: 36701152 PMCID: PMC9880797 DOI: 10.1001/jamanetworkopen.2022.53204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
IMPORTANCE COVID-19 has had a major effect on health care activities, especially surgery. At first, comparisons were proposed using 2019 activities as the highest standard. However, while such an approach might have been suitable during the first months of the pandemic, this might no longer be the case for a longer period. OBJECTIVE To examine approaches that may better assess the use of cancer surgeries. DESIGN, SETTING, AND PARTICIPANTS In a cross-sectional design, the nationwide French hospital facility data (Medicalised Information System Program) were used to assess cancer surgery for 6 cancer site categories in adults from January 1, 2010, to December 31, 2021. EXPOSURE Estimated cancer surgery activity during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Three models were proposed to assess the expected number of surgical procedures between 2020 and 2021 and make a comparison with those observed in earlier years. RESULTS In France, cancer removal surgeries account for approximately 7000 hospitalizations per year for liver cancer; 4000 for pancreatic cancer; 7700 for ovarian cancer; 1300 for esophagus cancer; 23 000 for ear, nose, and throat (ENT) cancer; 78 000 for breast cancer; and 16 600 for thoracic cancers. For most cancer sites, the number of surgical procedures increased from 2010 to 2019: liver, 14%; pancreas, 38%; ovary, 14%; esophagus, 18%; breast, 8%; and thoracic, 29%. Assuming stability, these values underestimate the gap in activity observed in 2020-2021. For other procedures, a decrease was observed: stomach, -10%, and ENT, -6%. Assuming stability, these values overestimate the gap in activity observed in 2020-2021. At the end of 2021, according to the model, the gap in activity observed in 2020-2021 was estimated at between -1.4% and 1.7% for breast, -6.6% and -7.3% for thoracic, -3.1% and -2.5% for ovarian, -4.2% and -1.7% for pancreas, -6.7% and 5.9% for stomach, and -13.0% and -13.9% for esophageal cancers. For ENT, liver, and urologic cancers, because the trend was different before and after 2015, it was necessary to opt for modeling using only the most recent period. The cumulative gap in activity observed in 2020-2021 was estimated at -1.0% for ENT cancers, -5.3% for liver cancers, and -2.9% for urologic cancers. CONCLUSIONS AND RELEVANCE The findings of this study suggest that short- and medium-term trends must be considered to estimate COVID-19 cancer surgery activities. Breast cancer is the site for which the activity showed the smallest decrease during the pandemic, with almost full recovery in 2021.
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Affiliation(s)
- Christine Le Bihan-Benjamin
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Mathieu Rocchi
- Health Data and Assessment Department, Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Maxime Putton
- Care Paths Organization Department, Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Jean-Baptiste Méric
- Public Health Division, National Cancer Institute, Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey Data Science and Assessment Division, National Cancer Institute, Boulogne-Billancourt, France
- Aix Marseille University, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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Maeda K, Shigemura K, Fang SB, Yang YM, Chiang YT, Sung SY, Chen KC, Nakano Y, Miyara T, Fujisawa M. A comparison of the impact of the COVID-19 pandemic on urological surgeries in Japan and Taiwan. Int J Urol 2023; 30:43-49. [PMID: 36594525 DOI: 10.1111/iju.15056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 09/07/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE We report the impact of the COVID-19 pandemic on urological surgeries and hospital policies at two hospitals in Japan and Taiwan. METHODS We retrospectively surveyed the number of surgeries every 3 months in the Urology Department of Kobe University Hospital (KUH), Kobe, Japan before (January 2019-March 2020) and after (April 2020-September 2021) the COVID-19 outbreak, and in the Urology Department of Shuang Ho Hospital, Taipei Medical University (SHH-TMU), Taiwan before (January 2021-March 2021) and after (April 2021-September 2021) the outbreak, and compared the averages and types of surgery. RESULTS In Kobe, COVID-19 patients were stratified such that other regional hospitals gave priority to treating COVID-19 while KUH gave priority to treating non-COVID-19 patients. In KUH, the number of surgeries did not change significantly, 237.2 ± 29.6 versus 246.3 ± 20.8 (p = 0.453). In Taiwan COVID-19 patients increased sharply in May 2021, and teaching hospitals in Taiwan were obliged to provide 20% of their total beds for COVID-19 patients. At SHH-TMU, there was a 33.3% drop in the number of surgeries during April-June 2021 compared to the pre-pandemic average. However, no significant changes were observed, 423.4 ± 68.4 versus 373 ± 91.0 (p = 0.298), because of the subsequent success in controlling the COVID-19 infection. CONCLUSIONS The comparison of infection control measures between the two countries revealed that while both KUH and SHH-TMU successfully maintained the number of surgeries, the reasons for this were different for each.
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Affiliation(s)
- Koki Maeda
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Shiuh-Bin Fang
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Medical University Shuang Ho Hospital, Taipei, Taiwan
| | - Young-Min Yang
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yi-Te Chiang
- Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Shian-Ying Sung
- The International Ph.D. Program for Translational Science, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Chen
- Department of Urology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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Zapała P, Ślusarczyk A, Rajwa P, Przydacz M, Krajewski W, Dybowski B, Kubik P, Kuffel B, Przudzik M, Osiecki R, Stamirowski R, Zapała Ł, Kozikowski M, Chorągwicki D, Szymańska M, Kiełb P, Małkiewicz B, Zostawa J, Roslan M, Zajączkowska J, Jarzemski M, Brzoszczyk B, Petrasz P, Jarzemski P, Zdrojowy R, Dobruch J, Paradysz A, Drewa T, Chłosta P, Radziszewski P. Not as black as it is painted? The impact of the first wave of COVID-19 pandemic on surgical treatment of urological cancer patients in Poland - a cross-country experience. Arch Med Sci 2023; 19:107-115. [PMID: 36817674 PMCID: PMC9897107 DOI: 10.5114/aoms/130927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In the majority of Western European countries, the coronavirus disease (COVID-19) pandemic has led to a dramatic reduction in urooncological surgeries. Our objective was to evaluate the impact of the pandemic on volume and patterns of urooncological surgery in Poland. MATERIAL AND METHODS This is a retrospective analysis of 10 urologic centres in Poland. Data regarding major oncological procedures performed after the COVID-19 pandemic outbreak (March 15, 2020 - May 31, 2020) were evaluated and compared with data from the respective period in 2019. RESULTS Between March 15, 2020 and May 31, 2020, a total of 968 oncological procedures were performed in participating centres. When compared to the respective period in 2019 (1063 procedures) the overall number of surgeries declined by 8.9%. The reduction was observed for transurethral resection of bladder tumour (TURBT) (20.1%) and partial nephrectomies (PN) (16.5%). Surgical activity considering radical nephrectomy (RN), nephroureterectomy (NU), and radical prostatectomy (RP) remained relatively unchanged, whereas radical cystectomy (RC) burden showed a significant increase (90.9%). Characteristics of patients treated with TURBT, RC, NU, PN, and RN did not differ significantly between the compared periods, whereas RP in the COVID-19 period was performed more frequently in patients with a higher grade group (p = 0.028) and positive digital rectal examination (p = 0.007). CONCLUSIONS Surgical activity for urological cancers in Poland has been maintained during the first wave of the COVID-19 pandemic. The Polish strategy in the initial period of the COVID-19 crisis mirrors the scenario of hard initial lockdown followed by adaptive lockdown, during which oncological care remained undisrupted and did not require particular priority triage.
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Affiliation(s)
- Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksander Ślusarczyk
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Rajwa
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Krajewski
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszkow, Poland
| | - Przemysław Kubik
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Błażej Kuffel
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Maciej Przudzik
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Rafał Osiecki
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Remigiusz Stamirowski
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
| | - Mieszko Kozikowski
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Dominik Chorągwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Szymańska
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Paweł Kiełb
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Małkiewicz
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Zostawa
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Marek Roslan
- Department of Urology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
| | - Joanna Zajączkowska
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Marcin Jarzemski
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Bartosz Brzoszczyk
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Piotr Petrasz
- Department of Urology and Urooncology, Multispecialty Regional Hospital, Gorzow Wielkopolski, Poland
| | - Piotr Jarzemski
- Department of Urology, Jan Biziel University Hospital, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Romuald Zdrojowy
- Department of Urology and Oncologic Urology, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, Professor W. Orłowski Independent Public Teaching Hospital, Warsaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, Katowice, Poland
| | - Tomasz Drewa
- Department of General and Oncologic Urology, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Piotr Chłosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, Warsaw, Poland
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Ratajczak JM, Gawrońska A, Fischer M, Hladun T, Marczak M. Can We Identify Patients in Danger of Delayed Treatment? Management of COVID-19 Pandemic Backlog in Urology Care in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16547. [PMID: 36554427 PMCID: PMC9779168 DOI: 10.3390/ijerph192416547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic had a tremendous impact on healthcare systems around the world. This study aims to research the course of surgical treatment in urology during the pandemic in 2020, evaluate the volume of deferred treatment in urology in Poland, and indicate groups of patients that are especially vulnerable to a delay in the delivery of healthcare services. The National Health Found statistics (NHF) database was searched for information on procedures completed in urology departments from 2015 to 2020. Changes in hospital discharges of adults from 2019 to 2021 were investigated using monthly reports of NHF on patient billing groups. Statistics of PSA, testosterone, and creatinine testing were extracted from NHF reports. Annual changes in the number of surgeries were calculated. Then, the estimation of the expected quantity of procedures without the occurrence of the pandemic was performed using linear regression based on data from 2015 to 2020. The estimation was assumed reliable at R2 > 0.8. The difference between collected and estimated data was analysed. In 2020, the volume of radical prostatectomies, cystectomies, and kidney surgeries noted downturns following lockdowns in March and November. All analysed procedures, except radical cystectomy, noted a reduction in the entire year. The declines reached -34% in shockwave lithotripsy, -13% in ureterorenoscopic lithotripsy, -22% in cystolithotripsy, -28% in percutaneous lithotripsy, -12% in transurethral resection of a bladder tumour (TURBT), -31% in transurethral resection of the prostate, -15% in nephrectomy and kidney tumorectomy, and -10% in radical prostatectomy. Among the analysed procedures, only radical cystectomy rates increased 5%. Prostate-specific antigen and creatinine tests fell -17%, and testosterone testing was down -18%. In conclusion, the patients most vulnerable to delayed treatment due to the post-pandemic backlog are those requiring TURBT, kidney cancer operations, and radical prostatectomies. Solving backlogs in urology should prioritise cancer patients and thus requires improved access to cystoscopy, TURBT, diagnoses and surgery of prostate and kidney tumours. Addressing the needs of patients suffering from benign diseases demands appropriate measures to increase the surgical productivity of urology departments.
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Affiliation(s)
- Jakub Marek Ratajczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland
| | - Anna Gawrońska
- Łukasiewicz Research Network, Poznań Institute of Technology, 61-755 Poznań, Poland
| | - Margaret Fischer
- Faculty of Pharmacy, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Taras Hladun
- Urology Department, Regional Specialized Hospital in Nowa Sól, 67-100 Nowa Sól, Poland
| | - Michał Marczak
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-647 Lodz, Poland
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10
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Impact of COVID-19 on urology services at a quaternary referral center in Johannesburg, South Africa. Curr Urol 2022. [DOI: 10.1097/cu9.0000000000000168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Gaither TW, Patel P, Del Rosario C, Baxter ZC, Pannell S, Dunn M. Predictive Value of Voiding Efficiency After Active Void Trial in Men Undergoing BPH Surgery. Urology 2022; 168:169-174. [PMID: 35697225 DOI: 10.1016/j.urology.2022.05.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the predictive value of voiding efficiency on acute urinary retention after discharge from BPH surgery. MATERIALS AND METHODS We performed a prospective observational cohort study of three surgeons' practices from 2019 to present. All men included underwent trial of void on post-operative day one after transurethral resection of prostate or Holmium enucleation of prostate . Active filling void trials were performed on all patients and voiding efficiency (percent of bladder volume emptied) was calculated. Multivariable logistic regression was performed to determine predictors of developing acute urinary retention. RESULTS During the study period, 188 men met inclusion criteria. 110 (59%) men underwent Holmium enucleation of prostate , and 78 (41%) underwent transurethral resection of prostate. The median age of our cohort was 70 (IQR 65-75). The median prostate size was 100g (IQR 61-138g). Nineteen patients (10%) returned after discharge with acute urinary retention requiring catheterization. On post-operative day one, the median voiding efficiency was 75% (IQR 55%-94%). On multivariable analysis, patients with a voiding efficiency less than 50% were 3.8 times more likely (95% confidence interval 1.1-12.8) to develop subsequent retention compared to a voiding efficiency of greater than 75%. Increasing pre-operative prostate size was associated with lower risk of urinary retention after discharge (aOR 0.8, 95%CI 0.6-0.9). CONCLUSIONS Voiding efficiency after an active void trial helps stratify risk of urinary retention in patients undergoing benign prostate surgery. High-risk patients include those with voiding efficiencies less than 50% and smaller pre-operative prostate sizes (<80g).
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Affiliation(s)
- Thomas W Gaither
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA.
| | - Parth Patel
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | | | - Z Chad Baxter
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Stephanie Pannell
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Matthew Dunn
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA
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12
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Impact of COVID-19 on Society of Urologic Oncology fellowship operative volumes. Urol Oncol 2022; 40:490.e7-490.e11. [PMID: 36182615 PMCID: PMC9452401 DOI: 10.1016/j.urolonc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022]
Abstract
Purpose The COVID-19 pandemic impacted all aspects of healthcare including surgical training. Our objective was to assess the impact of the pandemic on surgical case volumes of graduating Society of Urologic Oncology (SUO) fellows during the academic years 2019 to 2020 and 2020 to 2021. Materials and methods Deidentified case logs for graduating SUO fellows from 2017 to 2021 were obtained from the SUO Education Committee. Cases are stratified by category and minimally invasive surgery (MIS) or open approach. Graduates of 2017, 2018, and 2019 were combined into a pre-COVID cohort and compared to COVID-affected 2020 and 2021 cohorts. Total case volumes, case category volumes, and surgical approach type were compared with Kruskal-Wallis test. Results A total of 173 graduating SUO fellow case logs were analyzed with 100, 38, and 35 in the pre-COVID and COVID-affected 2020 and 2021 cohorts, respectively. All fellow logs were obtained for 2017 to 2020 graduates while 5 of 40 were missing for the 2021 cohort. There was no statistical difference in median total cases across cohorts (P = 0.52). For the first COVID-affected cohort of 2020, they reported significantly fewer total MIS cases in 2020 compared to pre-COVID fellows (median 92.5 vs. 135 pre-COVID, P = 0.002). However, there were no significant differences among the tracked oncologic MIS categories except a statistically significant increase in MIS retroperitoneal lymph node dissection between 2020 and 2021 COVID-affected cohorts (0 vs. 2, P = 0.033) Conclusions The oncologic case volumes of the initial SUO fellows graduating during COVID pandemic were minimally affected. This national deidentified data is reassuring that oncologic training has not been impacted by widespread decreases in case volume. However, impacts on individuals, programs or geographic regions may have varied.
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Hentzen C, Haddad R, Turmel N, Biardeau X, Bey E, Amarenco G, Denys P, Gamé X, Phé V, Peyronnet B, Perrouin-Verbe MA, Joussain C. [Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. Prog Urol 2022; 32:635-655. [PMID: 35659166 DOI: 10.1016/j.purol.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.
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Affiliation(s)
- C Hentzen
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - R Haddad
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - N Turmel
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France; Département de médecine physique et de réadaptation, hôpital Danièle-Casanova, 93205 Saint-Denis, France
| | - X Biardeau
- Département d'urologie, université de Lille, CHU de Lille, hôpital Claude-Huriez, 59000 Lille, France
| | - E Bey
- Département d'urologie et d'andrologie, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - G Amarenco
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - P Denys
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
| | - X Gamé
- Département d'urologie, transplanttion rénale et andrologie, CHU de Rangueil, TSA 50032, 31059 Toulouse, France
| | - V Phé
- Département d'urologie, Sorbonne Université, hôpital Tenon, AP-HP, Paris, France
| | - B Peyronnet
- Département d'urologie, université de Rennes, Rennes, France
| | - M A Perrouin-Verbe
- Département d'urologie, University of Nantes, hôtel Dieu Hospital, Nantes, France
| | - C Joussain
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
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Impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. Cancer Treat Res Commun 2022; 31:100553. [PMID: 35421819 PMCID: PMC8975755 DOI: 10.1016/j.ctarc.2022.100553] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/20/2022]
Abstract
Introduction The COVID-19 outbreak has affected care for non-COVID diseases like cancer. We evaluated the impact of the COVID-19 outbreak on prostate cancer care in the Netherlands. Methods Prostate cancer diagnoses per month in 2020–2021 versus 2018–2019 were compared based on preliminary data of the Netherlands Cancer Registry (NCR) and nationwide pathology network. Detailed data was retrieved from the NCR for the cohorts diagnosed from March-May 2020 (first COVID-19 wave) and March-May 2018–2019 (reference). Changes in number of diagnoses, age, disease stage and first-line treatment were compared. Results An initial decline of 17% in prostate cancer diagnoses during the first COVID-19 wave was observed. From May onwards the number of diagnoses started to restore to approximately 95% of the expected number by the end of 2020. Stage at diagnosis remainedstable over time. In low-risk localised prostate cancer radical prostatectomy was conducted more often in week 9–12 (21% versus 12% in the reference period; OR=1.9, 95% CI; 1.2–3.1) and less active surveillance was applied (67% versus 78%; OR=0.6, 95% CI; 0.4–0.9). In the intermediate-risk group, a similar change was observed in week 13–16. Radical prostatectomy volumes in 2020 were comparable to 2018–2019. Conclusion During the first COVID-19 wave the number of prostate cancer diagnoses declined. In the second half of 2020 this largely restored although the number remained lower than expected. Changes in treatment were temporary and compliant with adapted guidelines. Although delayed diagnoses could result in a less favourable stage distribution, possibly affecting survival, this seems not very likely.
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Herzberg H, Savin Z, Lasmanovich R, Marom R, Ben‐David R, Mano R, Yossepowitch O, Sofer M. Impact of COVID‐19 pandemic on patients with obstructing urinary stones complicated by infection. BJUI COMPASS 2022; 3:298-303. [PMID: 35783587 PMCID: PMC9231673 DOI: 10.1002/bco2.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/04/2022] [Accepted: 03/01/2022] [Indexed: 11/08/2022] Open
Abstract
Objective To assess the influence of COVID‐19‐imposed life changes on presentation and outcomes of patients with obstructing urinary stones complicated by infection. Patients and methods All patients presenting with obstructing urinary stones and infection 1 year before the pandemic (March 2019 to February 2020; n = 66) and 1 year since its onset (March 2020 to February 2021; n = 45) were enrolled. Demographics, clinical presentation, laboratory panel, stone characteristics and outcomes were compared between groups. Univariate and multivariate logistic regression models were performed for analysis. Results The COVID‐19 period was characterised by younger patients, female predominance, higher temperature at presentation and more bilateral obstructing stones (p < 0.05). The admission rate to intensive care units was double that of the pre‐pandemic period, whereas time between diagnosis and treatment was similar. The univariate analysis revealed higher rates of severe sepsis (odds ratio [OR] = 3, p = 0.01), systemic inflammatory response syndrome (SIRS) ≥ 2 (OR = 2.9, p = 0.01) and risk, injury, failure, loss of kidney function and end‐stage kidney (RIFLE) criteria ≥ 1 (OR = 2.2, p = 0.04) in the pandemic period group. The multivariate analyses revealed the COVID‐19 period as being the sole variable associated with severe sepsis (OR = 3.1, p = 0.02), SIRS ≥ 2 (OR = 3.8, p = 0.005) and RIFLE ≥ 1 (OR = 2.6, p = 0.05). Conclusions The pandemic period was characterised by a worse clinical state at presentation of patients with obstructing urinary stones complicated by infection, probably reflecting delay in arrival to emergency services.
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Affiliation(s)
- Haim Herzberg
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Ziv Savin
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Rinat Lasmanovich
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Ron Marom
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Reuben Ben‐David
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Roy Mano
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Mario Sofer
- Department of Urology, Tel‐Aviv Sourasky Medical Center Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
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Noureldin YA, Elmohamady B, El-Dakhakhny AS, Omar M, Desoky EE, Ghazwani Y, Hamri SB, Alkhayal A, Alrabeeah K, Kamal W, Farag F, Farahat Y. How did the first year of the COVID-19 pandemic affect urology practice in Arab countries? A cross-sectional study by the Arab Association of Urology research group. Ther Adv Urol 2022; 14:17562872221079492. [PMID: 35251310 PMCID: PMC8891825 DOI: 10.1177/17562872221079492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022] Open
Abstract
Objective: The aim of this study was to assess of the effect of coronavirus disease 2019 (COVID-19) pandemic on urology practice in the Arab world during the first year of the crisis. Methods: An Internet-based questionnaire was created and sent out via email to members of the Arab Association of Urology (AAU) using ‘Google Forms’. The survey assessed participants’ demographics in terms of age, gender, country of origin, type of practice and position. Impacts of COVID-19 on urological practice were assessed in terms of the changes in hospital policies regarding consultations, and elective and emergency surgical cases. Moreover, impacts of COVID-19 on urologists were assessed. Results: A total of 255 AAU members across 14 Arab countries (Emirates, Egypt, Saudi Arabia, Iraq, Jordan, Algeria, Kuwait, Yemen, Qatar, Lebanon, Libya, Oman, Sudan and Syria) completed the survey; 4% were female urologists. Consultations at outpatient clinics were closed or restricted to emergency cases or replaced by telemedicine in almost 15%, 40% and 25% of hospitals, respectively. Elective surgeries were stopped or reduced to under 25% of surgical capacity in >10% and about 25% of hospitals, respectively. Almost 90% (228) reported changes in the policy for emergency theatres. Nearly 65% of hospitals offered preoperative COVID-19 testing to patients and 50% of hospitals provided personal protective equipment (PPE) to their urologists. Of 99% (253) who reported a change in urological education, 95% relied on online webinars. About 56% of respondents had their own private practice, of whom 91% continued private practice during the crisis. About 38% of participants reported exposure to intimidation (75% emotional, 20% verbal and 5% physical). Conclusion: The COVID-19 pandemic resulted in major changes in hospitals’ policies regarding outpatient consultations, elective and emergency operative cases, and the shift to telemedicine. Arab urologists have been facing major challenges either in both the governmental or the private sectors, and some of them were exposed to emotional, verbal and even physical intimidation.
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Affiliation(s)
- Yasser A. Noureldin
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha 13511, Egypt
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
| | - Basheer Elmohamady
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr S. El-Dakhakhny
- Department of Urology, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed Omar
- Department of Urology, Menoufiya University Hospital, Menoufiya, Egypt
| | - Esam E.A. Desoky
- Department of Urology, Zagazig University Hospital, Zagazig, Egypt
| | - Yahia Ghazwani
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saeed Bin Hamri
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
| | - Abdullah Alkhayal
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Khalid Alrabeeah
- Division of Urology, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Wissam Kamal
- Department of Urology, King Fahd Hospital, Jeddah, Saudi Arabia
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - Yasser Farahat
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Urology Department, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates
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TAHRA A, DINCER M, ONUR R. Impact of the COVID-19 Pandemic on Functional Urology Practice: A Nationwide Survey From Turkey. Medeni Med J 2022; 37:71-78. [PMID: 35306788 PMCID: PMC8939453 DOI: 10.4274/mmj.galenos.2022.97450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Artificial intelligence for target prostate biopsy outcomes prediction the potential application of fuzzy logic. Prostate Cancer Prostatic Dis 2022; 25:359-362. [PMID: 34480083 PMCID: PMC8413110 DOI: 10.1038/s41391-021-00441-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND In current precision prostate cancer (PCa) surgery era the identification of the best patients candidate for prostate biopsy still remains an open issue. The aim of this study was to evaluate if the prostate target biopsy (TB) outcomes could be predicted by using artificial intelligence approach based on a set of clinical pre-biopsy. METHODS Pre-biopsy characteristics in terms of PSA, PSA density, digital rectal examination (DRE), previous prostate biopsies, number of suspicious lesions at mp-MRI, lesion volume, lesion location, and Pi-Rads score were extracted from our prospectively maintained TB database from March 2014 to December 2019. Our approach is based on Fuzzy logic and associative rules mining, with the aim to predict TB outcomes. RESULTS A total of 1448 patients were included. Using the Frequent-Pattern growth algorithm we extracted 875 rules and used to build the fuzzy classifier. 963 subjects were classified whereas for the remaining 484 subjects were not classified since no rules matched with their input variables. Analyzing the classified subjects we obtained a specificity of 59.2% and sensitivity of 90.8% with a negative and the positive predictive values of 81.3% and 76.6%, respectively. In particular, focusing on ISUP ≥ 3 PCa, our model is able to correctly predict the biopsy outcomes in 98.1% of the cases. CONCLUSIONS In this study we demonstrated that the possibility to look at several pre-biopsy variables simultaneously with artificial intelligence algorithms can improve the prediction of TB outcomes, outclassing the performance of PSA, its derivates and MRI alone.
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Pecoraro A, Roussel E, Serni S, Campi R. Re-envisioning Patient Education and Public Awareness of Urological Cancers at the Time of the COVID-19 Pandemic. EUR UROL SUPPL 2022; 38:67-68. [PMID: 35224515 PMCID: PMC8864105 DOI: 10.1016/j.euros.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Eduard Roussel
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- European Association of Urology Young Academic Urologists Renal Cancer Working Group, Arnhem, The Netherlands
- Corresponding author. Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Largo Brambilla 3, 50134 Firenze, Italy. Tel. +39 055 2758020; Fax: +39 055 2758014.
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20
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Impact of COVID-19 pandemic on diagnosis and surgical management of common urological conditions: results from multi-institutional database analysis from the United States. World J Urol 2022; 40:2717-2722. [PMID: 36181552 PMCID: PMC9526193 DOI: 10.1007/s00345-022-04167-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/24/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine real life impact during the first pandemic year on diagnosis and surgical management of common urological diseases and 90-day postoperative mortality following common urological surgeries. METHODS Cross-sectional study from 2016 to 2021. We used TriNetX to obtain the data. Patients with a diagnosis of six common non-oncologic and five oncologic urologic conditions were included. Twenty-four surgical interventions were also analyzed. The total number of diagnosis and surgical procedures were compared yearly from 2016 to 2021 and Chi-square test was used for statistical analysis. Additionally, monthly changes were evaluated during the first pandemic year and a z score period time was reported. The 90-day post-operative mortality rates during the first pandemic year were compared to the preceding year. RESULTS Overall, a decrease in diagnosis and surgeries were observed during the first pandemic year, with maximum drop in April 2020. Among non-oncological conditions, the decrease in diagnosis of enlarged prostate (5.3%), nephrolithiasis (9.4%), urinary incontinence (18.7%), and evaluation for male sterilization (14.8%) reached statistical significance (P < 0.05 in all). Prostate cancer was the only cancer whose diagnosis showed statistically significant decrease (6.2%, P < 0.05). The surgical case load for benign conditions showed higher reduction (13.1-25%) than for malignant conditions (5.9-16.3%). There was no change in 90-day post-operative mortality in any of the analyzed surgeries. CONCLUSIONS Our study showed that although healthcare delivery decreased in the first pandemic year, causing a decline in the diagnosis and surgical treatment of several diseases, surgical interventions did not increase the risk of death.
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21
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Khene ZE, Guérin S, Khene F, Pradère B, Roumiguié M, Mathieu R, Pignot G, Massard C, Neuzillet Y, Ploussard G, Bigot P, De la taille A, Rouprêt M, Bensalah K. Online Public Interest in Urological Cancers During the COVID-19 Pandemic: What Can “Dr. Google” Teach Us? EUR UROL SUPPL 2022; 37:73-79. [PMID: 35072118 PMCID: PMC8761543 DOI: 10.1016/j.euros.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 01/23/2023] Open
Abstract
Background Objective Design, setting, and participants Outcome measurements and statistical analysis Results and limitations Conclusions Patient summary
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22
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Huang W, Chiang CH, Chen WJ, Huang IS, Huang EH, Chung HJ. Impact of COVID-19 pandemic on urological service: Experience at a Taiwanese tertiary center. UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_119_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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23
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Guerrieri R, Rovati L, Dell’Oglio P, Galfano A, Ragazzoni L, Aseni P. Impact of the COVID-19 Pandemic on Urologic Oncology Surgery: Implications for Moving Forward. J Clin Med 2021; 11:171. [PMID: 35011911 PMCID: PMC8745246 DOI: 10.3390/jcm11010171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 12/17/2022] Open
Abstract
The COVID-19 pandemic has caused the destruction of routine hospital services globally, leading to an increase in the backlog of elective surgery cases. The aim of the study was to retrospectively investigate the pandemic's impact on the urologic oncology surgical activity of a high-volume center located in Milan, Italy. The number and type of procedures performed in 2020 during the COVID-19 pandemic was evaluated using 2019 data as control. Waiting times for each surgical procedure were compared, on a bimonthly basis, between the two different years. Overall, a 26.7% reduction in the number of urologic oncology surgeries between 2019 and 2020 was observed (2019: 720, 2020: 528). Both the main indication for surgery and the type of procedure performed significantly differed between 2019 and 2020 (all p < 0.0001), with a decrease in the number of radical prostatectomies and an increase in the number of radical cystectomies and radical nephrectomies/nephroureterectomies performed in 2020. Waiting time decreased by 20% between 2019 and 2020, with the most significant reduction seen after the first wave of the COVID-19 pandemic (July-October 2020), in particular for partial nephrectomy and radical prostatectomy, possibly due to the underdiagnosis of cases. In conclusion, in accordance with recommendations by international urological societies on prioritization strategies for oncological procedures, a higher proportion of surgeries for high-risk tumors was performed in 2020 at our center at the expense of procedures for lower risk diseases; however, future implications for patients' prognosis still need to be determined.
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Affiliation(s)
- Rossella Guerrieri
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (R.G.); (P.A.)
| | - Lucrezia Rovati
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (R.G.); (P.A.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy
| | - Paolo Dell’Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (P.D.); (A.G.)
| | - Antonio Galfano
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (P.D.); (A.G.)
| | - Luca Ragazzoni
- CRIMEDIM—Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, 28100 Novara, Italy;
| | - Paolo Aseni
- Emergency Department, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milano, Italy; (R.G.); (P.A.)
- Department of Biomedical and Clinical Sciences “L. Sacco”, Università degli Studi di Milano, 20157 Milano, Italy
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24
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Abou-Chedid W, Nason GJ, Evans AT, Yamada K, Moschonas D, Patil K, Langely SE, Perry MJ. The impact of COVID-19 on surgical volume and surgical training at a high-volume pelvic oncology centre. Urologia 2021; 89:495-499. [PMID: 34877900 DOI: 10.1177/03915603211062827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The coronavirus (COVID-19) pandemic has overwhelmed most health services. As a result, many surgeries have been deferred and diagnoses delayed. The aim of this study was to assess the effect of the COVID-19 pandemic at a high-volume pelvic oncology centre. METHODS A retrospective review was performed of clinical activity from 2017 to 2020. We compared caseload for index procedures 2017-2019 (period 1) versus 2020 (period 2) to see the effect of the COVID pandemic. We then compared the activity during the first lockdown (March 23rd) to the rest of the year when we increased our theatre access by utilising a 'clean' site. RESULTS The average annual number of robotic assisted radical cystectomy (RARC) and robotic assisted radical prostatectomy (RARP) performed during period 1 was 82 and 352 respectively. This reduced to 68 (17.1% reduction) and 262 (25.6% reduction) during period 2. The number of patients who underwent prostate brachytherapy decreased from 308 to 243 (21% reduction). The number of prostate biopsies decreased from 420 to 234 (44.3% reduction). The number of radical orchidectomies decreased from 18 to 11 (39% reduction). The mean number of RARC and RARP per month during period 2 was 5.5 and 22. This decreased to 4 and 9 per month during the first national lockdown but was maintained thereafter despite two further lockdowns. CONCLUSION There has been a substantial decrease in urological oncology caseload during the COVID pandemic. The use of alternate pathways such as 'clean' sites can ensure continuity of care for cancer surgery and training needs.
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Affiliation(s)
| | - Gregory J Nason
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Andrew T Evans
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Kohei Yamada
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | | | - Krishna Patil
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Stephen E Langely
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Matthew Ja Perry
- Department of Urology, Royal Surrey NHS Foundation Trust, Guildford, UK
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25
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Struck JP, Schnoor M, Schulze A, Hupe MC, Ozimek T, Oppolzer IA, Schnabel MJ, Burger M, Darr C, Gruenwald V, Hadaschik B, Weinke M, Kuebler H, Klockenbusch JC, Grabbert MT, Gratzke C, Kramer MW, Katalinic A, Merseburger AS. Impact of COVID-19 crisis on medical care of patients with metastasized uro-oncologic disease under systemic cancer therapy: a multicenter study in German university hospitals. World J Urol 2021; 40:409-418. [PMID: 34850270 PMCID: PMC8631559 DOI: 10.1007/s00345-021-03868-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To date, over 4.2 million Germans and over 235 million people worldwide have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Uro-oncology (UO) patients are particularly vulnerable but in urgent need of life-saving systemic treatments. Our multicentric study examined the impact of the COVID-19 crisis on the medical care of UO patients in German university hospitals receiving ongoing systemic anti-cancer treatment and to detect the delay of medical care, defined as deferred medical treatment or deviation of the pre-defined follow-up assessment. Methods Data of 162 UO patients with metastatic disease undergoing systemic cancer treatment at five university hospitals in Germany were included in our analyses. The focus of interest was any delay or change in treatment between February 2020 and May 2020 (first wave of the COVID-19 crisis in Germany). Statistical analysis of contingency tables were performed using Pearson’s chi-squared and Fisher’s exact tests, respectively. Effect size was determined using Cramér’s V (V). Results Twenty-four of the 162 patients (14.8%) experienced a delay in systemic treatment of more than 2 weeks. Most of these received immuno-oncologic (IO) treatments (13/24, 54.2%, p = 0.746). Blood tests were delayed or canceled significantly more often in IO patients but with a small effect size (21.1%, p = 0.042, V = 0.230). Treatment of patients with renal cell carcinoma (12/73, 16.4%) and urothelial carcinoma (7/32, 21.9%) was affected the most. Conclusions Our data show that the COVID-19 pandemic impacted the medical care of UO patients, but deferment remained modest. There was a tendency towards delays in IO and ADT treatments in particular.
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Affiliation(s)
- Julian P. Struck
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Maike Schnoor
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Andrea Schulze
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Marie C. Hupe
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Tomasz Ozimek
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Immanuel A. Oppolzer
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Marco J. Schnabel
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, University Hospital of Regensburg, Landshuter Straße 65, 93053 Regensburg, Germany
| | - Christopher Darr
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Viktor Gruenwald
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Boris Hadaschik
- Department of Urology, Pediatric Urology and Uro-Oncology, University Hospital of Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Maximilian Weinke
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
| | - Hubert Kuebler
- Department of Urology and Pediatric Urology, University Hospital of Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany
| | - Jonas C. Klockenbusch
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Markus T. Grabbert
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Christian Gratzke
- Department of Urology, University Hospital of Freiburg, Hugstetterstraße 55, 79106 Freiburg im Breisgau, Germany
| | - Mario W. Kramer
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
| | - Alexander Katalinic
- Department of Social Medicine and Epidemiology and Department of Cancer Epidemiology, University of Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany
| | - Axel S. Merseburger
- Department of Urology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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Campi R, Tellini R, Grosso AA, Pecoraro A, Mari A, Raspollini MR, Gacci M, Carini M, Serni S, Minervini A. Exploring the Diversity and Predictors of Histopathological Findings Across the European Association of Urology Guidelines Office Rapid Reaction Group Priority Groups for Patients with Renal Tumors: Implications for Individualized Prioritization of Renal Cancer Care. EUR UROL SUPPL 2021; 34:5-9. [PMID: 34761237 PMCID: PMC8567362 DOI: 10.1016/j.euros.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/17/2022] Open
Abstract
In response to the COVID-19 pandemic, the European Association of Urology (EAU) Guidelines Office Rapid Reaction Group (GORRG) defined priority groups to guide the prioritization of surgery for nonmetastatic renal cell carcinoma (RCC). In this study we explored the diversity and predictors of histopathological findings across the EAU GORRG priority groups using a large database of 1734 consecutive patients undergoing elective surgery for nonmetastatic renal masses between 2017 and 2020 at a referral institution. Overall, 940 (54.2%), 358 (20.6%), and 436 (25.2%) patients were classified as low-, intermediate-, and high-priority, respectively. The low-, intermediate-, and high-risk groups significantly differed regarding all primary histopathological outcomes: benign histology (21.6% vs 15.9% vs 6.4%; p < 0.001); non–organ-confined disease (5.0% vs 19.0% vs 45.4%; p < 0.001); and adverse pathological features according to validated prognostic models (including the median Leibovich score for clear-cell RCC: 0 vs 2 vs 4; p < 0.001). On multivariable analysis, beyond the EAU GORRG priority groups, specific patient and/or tumor-related characteristics were independent predictors of the aforementioned histopathological outcomes. To the best of our knowledge, our study shows for the first time the value of the EAU GORRG priority groups from a histopathological standpoint and supports implementation of such a prioritization scheme beyond the COVID-19 pandemic. Patient summary During the COVID-19 pandemic, the European Association of Urology designed a scheme to prioritize patients needing surgery for kidney cancer according to their tumor characteristics and symptoms. We used results from our hospital database to test the scheme and found that the priority classification can be used to predict cancer outcomes after surgery. This scheme may be useful in prioritizing kidney cancer surgeries after the COVID-19 pandemic.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Andrea Mari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
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27
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The development and application of a triage system for urolithiasis during COVID-19. World J Urol 2021; 40:577-583. [PMID: 34762172 PMCID: PMC8581286 DOI: 10.1007/s00345-021-03871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To balance epidemic prevention with the therapeutic needs of patients with urolithiasis during the COVID-19 pandemic, we developed a triage system to guide medical staff in making priority decisions. Methods The study began with a review of the literature to propose a theoretical framework. Then, focus groups were assembled to develop, supplement, refine and form a consensus on the indications of the triage system. Finally, the system was implemented in the clinic. The validity and reliability of the system were tested by a content validity index and the interrater reliability kappa coefficient. Changes in patient characteristics and waiting time before and after the epidemic were compared. Results The theoretical framework was based on disease pathophysiology, including obstruction, infection, kidney dysfunction, and other symptoms. With this guide, a 28-item triage system with categories of T1–5 (low priority to urgent) was developed. The content validity index and the interrater reliability coefficient were 0.833 and 0.812, respectively. During clinical application, although the total number of patients remained steady, the proportion of T1 decreased significantly; even though the overall waiting time of patients did not change significantly, it increased for T1 and decreased for T2–4 in 2020 compared with 2019 (P < 0.05). Conclusion This triage tool based on the dimensions of obstruction, infection, kidney dysfunction, and other symptoms has good psychometric properties and significant utility for prioritizing patients with urolithiasis during times of crisis. With this system, patients of moderate to high priority were treated promptly during the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03871-7.
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Hu B, Ruan Y, Liu K, Wei X, Wu Y, Feng H, Deng Z, Liu J, Wang T. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021; 18:1863-1871. [PMID: 34600862 PMCID: PMC8387224 DOI: 10.1016/j.jsxm.2021.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The psychological and sexual health of different populations are negatively affected during the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about psychological distress and erectile function of male recovered patients with COVID-19 in the long term. AIM We aimed to evaluate psychological distress and erectile function of male recovered patients with COVID-19 in the mid-to-long terms. METHODS We recruited 67 eligible male recovered patients with COVID-19 and followed them up twice within approximately 6 months of recovery time. The psychological distress and erectile function were assessed by validated Chinese version of paper questionnaires. OUTCOMES The primary outcomes were Symptom Checklist 90 questionnaire for psychological distress and International Index of Erectile Function-5 for erectile function. RESULTS In the first visit, COVID-19 patients with a median recovery time of 80 days mainly presented the following positive symptoms: Obsessive-Compulsive, additional items (ADD), Hostility, Interpersonal Sensitivity, Depression, and Somatization; while the dimension scores in Somatization, Anxiety, ADD, and Phobia were higher than Chinese male norms. Besides, the prevalence of erectile dysfunction (ED) in the first-visit patients was significantly higher than Chinese controls. In the second visit, the primary psychological symptoms of COVID-19 patients with a median recovery time of 174 days were Obsessive-Compulsive, ADD, Interpersonal Sensitivity, and Hostility, while all dimensions scores of Symptom Checklist 90 were lower than Chinese male norms. Moreover, second-visit patients had no significant difference with Chinese controls in ED prevalence. In addition, it suggested that GSI was the independent risk factor for ED in the regression analysis for the first-visit patients. CLINICAL IMPLICATIONS The study showed the changes of psychological symptoms and erectile function in COVID-19 recovered patients, and provided reference on whether psychological and sexual supports are needed after a period of recovery. STRENGTHS AND LIMITATIONS To our knowledge, it is the first study to comprehensively evaluate the psychological distress and erectile function of COVID-19 recovered patients in the mid-to-long terms. The main limitations were the low number of analyzed participants, and the psychological distress and erectile function of healthy Chinese men over the same period were not evaluated, and the psychological and sexual related data of participants prior to COVID-19 were not available. Additionally, there was a selection bias in comparing COVID-19 patients with healthy controls. CONCLUSION With less impact of COVID-19 event, the impaired erectile function and psychological distress improved in COVID-19 recovered patients with a recovery time of nearly half a year. Hu B, Ruan Y, Liu K, et al. A Mid-to-Long Term Comprehensive Evaluation of Psychological Distress and Erectile Function in COVID-19 Recovered Patients. J Sex Med 2021;18:1863-1871.
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Affiliation(s)
- Bintao Hu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yajun Ruan
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kang Liu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xian Wei
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yue Wu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Feng
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyao Deng
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jihong Liu
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Tao Wang
- Department of Urology, Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. EUR UROL SUPPL 2021; 33:28-41. [PMID: 34604814 PMCID: PMC8473553 DOI: 10.1016/j.euros.2021.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Context Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient’s quality of life.
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Loganathan J, Doumouchtsis SK. Impact of COVID-19 on management of urogynaecology patients: a rapid review of the literature. Int Urogynecol J 2021; 32:2631-2646. [PMID: 33533991 PMCID: PMC7856854 DOI: 10.1007/s00192-021-04704-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The coronavirus (COVID-19) pandemic has impacted health systems worldwide. There is a continuing need for clinicians to adapt practice to facilitate timely provision of medical care, whilst minimising horizontal transmission. Guidance and recommendations are increasingly available, and this rapid review aimed to provide a timely evidence synthesis on the current recommendations surrounding urogynaecological care. METHODS We performed a literature review using PubMed/Medline, Embase and Cochrane and a manual search of national and international societies for management recommendations for urogynaecological patients during the COVID-19 pandemic. RESULTS Nine guidance documents and 17 articles, including 10 reviews, were included. Virtual clinics are recommended for new and follow-up patients, to assess and initiate treatment, as well as triage patients who require face-to-face appointments. Outpatient investigations such as urodynamics and cystoscopy for benign indications can be deferred. Prolapse and continence surgery should be suspended, except in specific circumstances such as procidentia with upper tract complications and failed pessaries. There is no evidence to support a particular route of surgery, but recommendations are made to minimise COVID-19 transmission. CONCLUSIONS Urogynaecological patients face particular challenges owing to inherent vulnerabilities of these populations. Behavioural and medical therapies should be recommended as first line options and initiated via virtual or remote clinics, which are integral to management during the COVID-19 pandemic. Expanding the availability and accessibility of technology will be increasingly required. The majority of outpatient and inpatient procedures can be deferred, but the longer-term effects of such practices are unclear.
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Affiliation(s)
| | - Stergios K Doumouchtsis
- Epsom and St Helier University Hospitals NHS Trust, Dorking Road, Epsom, KT18 7EG, UK.
- St George's University of London, London, UK.
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University Medical School, Athens, Greece.
- American University of the Caribbean, School of Medicine, Pembroke Pines, FL, USA.
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Editorial commentary: Is social media a reliable source of information on Peyronie's disease treatment? Int J Impot Res 2021; 34:321-322. [PMID: 34593999 DOI: 10.1038/s41443-021-00475-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/05/2021] [Accepted: 09/20/2021] [Indexed: 11/08/2022]
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Desai C, Pearce I, Modgil V. Performing Sensitive Clinical Examinations During Urological Telemedicine Visits: How to Avoid Pitfalls? Res Rep Urol 2021; 13:739-744. [PMID: 34616694 PMCID: PMC8488042 DOI: 10.2147/rru.s313881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIMS The impact of coronavirus disease 2019 presented an unprecedented challenge to urological service globally. In many countries, outpatient clinics were cancelled, and the use of telemedicine visits was increased. For urological complaints, the need to perform a sensitive clinical examination via telemedicine posed an unfamiliar environment. Our aim is to explore the clinical and ethical factors involved in performing remote sensitive clinical examinations. METHODS A comprehensive review of literature and guidance from various medical bodies internationally was conducted using suitable keywords on the search engines of PubMed, SCOPUS, Google Scholar, and Research Gate in the first week of March 2021 including "COVID-19," "telemedicine," "urology," and "sensitive examinations." RESULTS Telemedicine reduced unnecessary visits to medical facilities and was useful for reducing the risk of transmission during the COVID-19 pandemic. We propose that in order to perform a sensitive clinical examination via telemedicine, the following four steps must be considered: assessment of the clinical need, obtaining informed consent, use of a chaperone, and thorough documentation. CONCLUSION Telemedicine will play a pivotal role in the future of urological practice beyond this present pandemic. However, sensitive clinical examinations using such technology must be performed in appropriate settings and situations. Suitable training, enhanced documentation, communication, and observing information governance guidance will aid in avoiding clinical and ethical pitfalls.
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Affiliation(s)
- Chaitya Desai
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Pearce
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Amparore D, Checcucci E, Serni S, Minervini A, Gacci M, Esperto F, Fiori C, Porpiglia F, Campi R. Urology Residency Training at the Time of COVID-19 in Italy: 1 Year After the Beginning. EUR UROL SUPPL 2021; 31:37-40. [PMID: 34396350 PMCID: PMC8342892 DOI: 10.1016/j.euros.2021.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 10/29/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to significant changes in urology practice and residency programs. One year ago, the first nationwide survey on this topic showed a dramatic impact of the acute phase of the pandemic on residents' training activities. Aiming to assess for the first time how the COVID-19 scenario reshaped the pattern of urology training over a whole pandemic year, a cross-sectional, 38-item, web-based survey was developed. Residents scored the percentage decrease of their involvement in various clinical and surgical activities during the period of March 2020-March 2021 (as compared with the pre-COVID period). Overall, 312/585 (53.3%) residents from 27 schools of urology were included. The proportions of those experiencing a significant decrease of training exposure were 13.6%, 28.8%, 26.7%, 46.9%, 37.6%, and 33.3% (as compared with 40.2%, 85.8%. 82.3%, 69.7%, 59.7%, and 50.2% in the previous survey) for on-call activities, outpatient visits, diagnostic procedures, endoscopic surgery, open surgery, and minimally invasive surgery, respectively. The most impactful reductions in training activities were reached by final-year residents. Our findings highlight that, even if less burdensome than expected, urology residency training (especially in endoscopic surgery) was highly affected throughout the whole past year. This critical gap of skills may jeopardize residents' training even beyond the COVID-19 pandemic. PATIENT SUMMARY In this study, we assessed whether the training activities of Italian urology residents were impacted negatively by a whole year of COVID-19 pandemic (March 2020-March 2021). We also compared our results with those reported in a previous survey evaluating how the coronavirus disease 2019 (COVID-19) pandemic changed the training pattern of urology residents during the peak of the outbreak in March 2020. We found a critical decrease in residents' activities (especially for those in their final years of residency and for surgical procedures) that, even if lower than expected, might negatively impact their education and training in the future.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Esperto
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
- Department of Urology, Campus Biomedico University, Rome, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
| | - on behalf of the European Society of Residents in Urology (ESRU)
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
- European Society of Residents in Urology (ESRU), Arnhem, The Netherlands
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
- Department of Urology, Campus Biomedico University, Rome, Italy
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Culpan M, Keser F, Acar HC, Otunctemur A, Kucuk EV, Erdem S, Ozer M, Sen UT, Degirmenci E, Ergul R, Atis RG, Yildirim A. Impact of delay in cystoscopic surveillance on recurrence and progression rates in patients with non-muscle-invasive bladder cancer during the COVID-19 pandemic. Int J Clin Pract 2021; 75:e14490. [PMID: 34117682 PMCID: PMC8420249 DOI: 10.1111/ijcp.14490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/09/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To evaluate the impact of delay in cystoscopic surveillance on recurrence and progression rates in non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS A total of 407 patients from four high-volume centres with NMIBC that applied for follow-up cystoscopy were included in our study prospectively. Patients' demographics and previous tumour characteristics, the presence of tumour in follow-up cystoscopy, the pathology results of the latest transurethral resection of bladder tumour (if tumour was detected) and the delay in cystoscopy time were recorded. Our primary outcomes were tumour recurrences detected by follow-up cystoscopy and progression. Multivariate logistic regression analysis was performed using the possible factors identified with univariate analyses (P values ≤ .2). RESULTS A total of 105 patients (25.8%) had tumour recurrence in follow-up cystoscopy, and 20 (5.1%) of these patients had disease progression according to grade or stage. In multivariate analysis, the number of recurrences (OR: 1.307, P < .001) and the cystoscopy delay time (62-147 days, OR: 2.424, P = .002; >147 days, OR: 4.883, P < .001) were significant risk factors for tumour recurrence on follow-up cystoscopy; the number of recurrences (OR: 1.255, P = .024) and cystoscopy delay time (>90 days, OR: 6.704, P = .002) were significant risk factors for tumour progression. CONCLUSIONS This study showed that a 2-5 months of delay in follow-up cystoscopy increases the risk of recurrence by 2.4-fold, and delay in cystoscopy for more than 3 months increases the probability of progression by 6.7-fold. We suggest that cystoscopic surveillance should be done during the COVID-19 pandemic according to the schedule set by relevant guidelines.
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Affiliation(s)
- Meftun Culpan
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Ferhat Keser
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Hazal Cansu Acar
- Department of Public HealthCerrahpasa Faculty of MedicineIstanbul University‐CerrahpasaIstanbulTurkey
| | - Alper Otunctemur
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Eyup Veli Kucuk
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Selcuk Erdem
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Murat Ozer
- Department of UrologyProf. Dr. Cemil Tascioglu City HospitalUniversity of Health SciencesIstanbulTurkey
| | - Ugur Tolga Sen
- Department of UrologyIstanbul Umraniye Training and Research HospitalUniversity of Health SciencesIstanbulTurkey
| | - Enes Degirmenci
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Rifat Ergul
- Department of UrologyIstanbul Faculty of MedicineIstanbul UniversityIstanbulTurkey
| | - Ramazan Gokhan Atis
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
| | - Asif Yildirim
- Department of UrologyFaculty of MedicineIstanbul Medeniyet UniversityIstanbulTurkey
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Khusid JA, Kashani M, Fink LE, Weinstein CS, Gupta M. The Impact of the COVID-19 Pandemic on Urology Residents: a Narrative Review. Curr Urol Rep 2021; 22:45. [PMID: 34427779 PMCID: PMC8382932 DOI: 10.1007/s11934-021-01063-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/30/2022]
Abstract
Purpose of Review The COVID-19 pandemic brought unprecedented challenges for urology resident education. In this review, we discuss the pandemic’s impact on urology trainees and their education. Recent Findings Urology trainees were often redeployed to frontline services in unfamiliar clinical settings. Residents often experienced increased levels of stress, anxiety, and depression. Many programs instituted virtual “check-ins” and formed liaisons with mental health services to foster cohesiveness. Urology trainees experienced the integration of telehealth into the clinical realm. Virtual surgery lectures and simulations were utilized to augment surgical education. Academic governing bodies upheld resident protections and provided dynamic guidance for training requirement throughout the pandemic. Medical students were unable to participate in traditional in-person away rotations and interviews, complicating the residency application process. Summary The COVID-19 pandemic shook the healthcare system and ushered in seismic changes for urology trainees worldwide. Though the longstanding effects of the pandemic remain to be seen, urology residents have demonstrated tremendous resilience and bravery throughout this challenging period, and those qualities will undeniably withstand the test of time.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Mahyar Kashani
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Lauren E Fink
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Corey S Weinstein
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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Liatsikos E, Tsaturyan A, Kyriazis I, Kallidonis P, Manolopoulos D, Magoutas A. Market potentials of robotic systems in medical science: analysis of the Avatera robotic system. World J Urol 2021; 40:283-289. [PMID: 34424374 PMCID: PMC8381715 DOI: 10.1007/s00345-021-03809-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/04/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To evaluate the potential opportunities and possible competitiveness of Avatera robotic system (ARS) (Avateramedical, Germany), and perform predictive cost-analysis for its implementation and dissemination. MATERIAL AND METHODS Our study employed a projective quantitative research design. SWOT (strengths, weaknesses, opportunities, threats) analysis was used to map ARS internal competencies towards external contexts, and potential opportunities and risks in the robotic market. The ARS purchase and procedural costs were evaluated in two different scenarios. RESULTS In the first scenario, setting the purchase cost of the Avatera at around $1.3-1.5 million, a total $400 procedural cost reduction compared to the RAS performed with the da Vinci Xi can be calculated. In the second scenario, with a purchase cos of the ARS of $700.000-800.000 and considering a 5-year period with an annual ARS volume of 500 procedures, only an additional $300 will be attributed to the robot itself. Our projections revealed that for an effective competition the purchase cost of ARS should range between $700.000 and $800.000 during the initial phase of market entry. The marketing strategy of the ARS should be oriented towards countries without any robotic system in operational use, followed by countries where the competition intensity in the marketplace is low. CONCLUSION The introduction of new robotic systems will greatly affect and reshape the market of robotic surgery. The ARS has all the technical capacity ensuring the performance of high-quality surgical procedures. A fast spread and implementation of the ARS could be expected should the purchase and maintenance costs be kept low.
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Affiliation(s)
- Evangelos Liatsikos
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece. .,Department of Urology, Medical University of Vienna, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.
| | - Arman Tsaturyan
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Iason Kyriazis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Panagiotis Kallidonis
- Department of Urology, University of Patras Medical School, University of Patras, Rio, 26500, Patras, Greece
| | - Dimitris Manolopoulos
- School of Social Sciences, Hellenic Open University, Athens, Greece.,Department of Business Administration, Athens University of Economics and Business, Athens, Greece
| | - Anastasios Magoutas
- School of Social Sciences, Hellenic Open University, Athens, Greece.,General Department, National and Kapodistrian University of Athens, Athens, Greece
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Hentzen C, Biardeau X, Turmel N, Haddad R, Bey E, Amarenco G, Denys P, Phé V, Perrouin-Verbe MA, Peyronnet B, Joussain C. Prioritization of risk situations in neuro-urology: guidelines from Association Française d'Urologie (AFU), Association Francophone Internationale des Groupes d'Animation de la Paraplégie (A.F.I.G.A.P.), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d'UroDynamique et de Pelvi-Périnéologie (SIFUD-PP). World J Urol 2021; 40:133-139. [PMID: 34402945 PMCID: PMC8369873 DOI: 10.1007/s00345-021-03804-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose The current health crisis has drastically impacted patient management in many fields, including neuro-urology, leading to a mandatory reorganization. The aim of this work was to establish guidelines regarding the prioritization and optimal timing of each step of neurogenic lower urinary tract dysfunction management. Methods A steering committee included urologists and physical medicine and rehabilitation practitioners. Based on a literature review and their own expertise, they established a comprehensive risk-situation list and built a risk scale, allowing multiple other experts to score each clinical situation. New recommendations were generated using a Delphi process approach. Results Forty-nine experts participated in the rating group. Among the 206 initial items, 163 were selected and divided into four domains, diagnosis and assessment, treatment, follow-up, and complications, and two sub-domains, general (applicable for all neurological conditions) and condition-specific [varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, dysraphism, lower motor neuron lesions)]. The resulted guidelines are expert opinions established by a panel of French-speaking specialists, which could limit the scalability of this work. Conclusions The present multidisciplinary collaborative work generates recommendations which complement existing guidelines and help clinicians to reorganize their patients’ list in the long term with a personalized medicine approach, in the context of health crisis or not. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03804-4.
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Affiliation(s)
- Claire Hentzen
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France.
| | - Xavier Biardeau
- Department of Urology, University of Lille, Claude Huriez Hospital, CHU Lille, 59000, Lille, France
| | - Nicolas Turmel
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
- Rehabilitation department, Danièle Casanova Hospital, 93205, Saint Denis, France
| | - Rebecca Haddad
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Elsa Bey
- Urology and Andrology Department, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Gérard Amarenco
- Department of Neuro-Urology, Sorbonne University, GRC 01, GREEN Group of Clinical REsEarch in Neurourology, AP-HP, Hôpital Tenon, 4, rue de la Chine, 75020, Paris, France
| | - Pierre Denys
- Neurourology and Andrology Unit, Department of Physical Medecine and Rehabilitation, Raymond-Poincaré, AP-HP, Université Paris-Saclay, UMR 1179 Inserm, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne University, AP-HP, Pitié-Salpêtrière Academic Hospital, Paris, France
| | | | | | - Charles Joussain
- Neurourology and Andrology Unit, Department of Physical Medecine and Rehabilitation, Raymond-Poincaré, AP-HP, Université Paris-Saclay, UMR 1179 Inserm, Paris, France
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John A, Mian M, Sreedharan S, Kahokehr AA. The impact of the coronavirus disease 2019 pandemic on elective urological procedures in Australia. Asian J Urol 2021; 9:35-41. [PMID: 34961839 PMCID: PMC8694839 DOI: 10.1016/j.ajur.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/03/2021] [Accepted: 04/02/2021] [Indexed: 01/03/2023] Open
Abstract
Objective To investigate the changes in elective private urological procedures in Australia during the coronavirus disease 2019 pandemic. Methods Data were extracted from publicly available datasets from Medicare Benefits Schedule using item numbers assigned to each commonly performed urological intervention. These procedures were divided into three groups: Oncological therapeutic, diagnostic, and non-oncological therapeutic procedures. A smoothing model, based on the historic procedure numbers from 2017 to 2019, was used to forecast monthly number of procedures performed in each category between January 2020 and June 2020. These forecasted models were compared with reported figures. Results A total of 108 169 procedures were performed between January 2020 and June 2020 based on the Medicare Benefits Schedule item numbers listed. There was a significant reduction (percentage change) in total procedures performed in April 2020 (−22.6%, 95% confidence interval [CI]: −28.7% to −15.4%) and May 2020 (−33.2%, 95% CI: −37.5% to −28.3%). There was a significant reduction in oncological therapeutic, non-oncological therapeutic, and diagnostic procedures performed in April 2020 and May 2020 (p<0.05). These numbers did not include procedures performed in public sector. Conclusion There was a significant reduction in total urological procedures (including diagnostic, oncological, and non-oncological) performed in months of April 2020 and May 2020 during time of federal restrictions. Both public and private healthcare sectors need to be supported in the upcoming months to prevent further delays in treatment and poorer clinical outcomes.
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Affiliation(s)
- Athul John
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Mustafa Mian
- Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - Subhashaan Sreedharan
- Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia
| | - Arman A Kahokehr
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Flinders University, Bedford Park, SA, Australia
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Bersanelli M, Porta C. Impact of SARS-CoV-2 Pandemic on Kidney Cancer Management. KIDNEY CANCER 2021. [DOI: 10.3233/kca-210112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The SARS-CoV-2 pandemic still has a huge impact on the management of many chronic diseases such as cancer. Few data are presently available reagarding how the management of renal cell carcinoma (RCC) has changed due to this unprecedented situation. OBJECTIVE: To discuss the challenges and issues of the diagnosis and treatment of RCC in the COVID-19 era, and to provide recommendations based on the collected literature and our personal experience. METHODS: Systematic review of the available Literature regarding the management of RCC during the SARS-CoV-2 pandemic. RESULTS: Our review showed a prevalence of narrative publications, raising the issue of the real relevance of the evidence retrieved. Indeed, the only original data about RCC and COVID-19 found were a small retrospective case series and two surveys, providing either patients’ or physicians’ viewpoints. CONCLUSIONS: The expected delayed diagnosis of RCC could lead to an increase of advanced/metastatic cases; thus, proper therapeutic choices for patients with small renal masses should be carefully evaluated case by case, in order to avoid negative effects on long-term survival rates. The controversial interaction between immune checkpoint blockade and COVID-19 pathogenesis is more hypothetical than evidence-based, and thus immunotherapy should not be denied, whenever appropriate. To avoid treatments which won’t have an impact on patients’ survival, a honest and accurate evaluation of the cost/benefit ratio of each treatment option should be always performed. Finally, SARS-CoV-2 swab positivity should not prevent the continuation of ongoing active treatments in asymptomatic cases, or or after symptoms’ resolution.
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Affiliation(s)
- Melissa Bersanelli
- Medicine and Surgery Department, University of Parma and Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Camillo Porta
- Department of Biomedical Sciences and Human Oncology, University of Bari ‘A. Moro’ and Division of Medical Oncology, A.O.U. Consorziale Policlinico di Bari, Bari, Italy
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Monmousseau F, Ramillon J, Dubnitskiy-Robin S, Faivre d’Arcier B, Le Verger M, Le Fol T, Bruyère F, Rusch E, Brunet-Houdard S, Pradère B. Relevance of Adopting a Hybrid Strategy Mixing Single-Use and Reusable Ureteroscopes for Stones Management: An Economic Study to Support the Best Strategy. J Clin Med 2021; 10:jcm10122593. [PMID: 34208267 PMCID: PMC8230737 DOI: 10.3390/jcm10122593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022] Open
Abstract
Endoscopic procedures such as ureteroscopy (URS) have seen a recent increase in single-use devices. Despite all the advantages provided by disposable ureteroscopes (sURSs), their cost effectiveness remains questionable, leading most teams to use a hybrid strategy combining reusable (rURS) and disposable devices. Our study aimed to create an economic model that estimated the cut-off value of rURS procedures needed to support the profitability of a hybrid strategy (HS) for ureteroscopy. We used a budget impact analysis (BIA) model that estimated the financial impact of an HS compared to 100% sURS use. The model included hospital volume, sterilization costs and the private or public status of the institution. Although the hybrid strategy generally remains the best economic and clinical option, a predictive BIA model is recommended for the decision-making. We found that the minimal optimal proportion of rURS procedures in an HS was mainly impacted by the activity volume and overall number of sterilization procedures. Private and public institutions must consider these variables and models in order to adapt their HS and remain profitable.
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Affiliation(s)
- Fanny Monmousseau
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
- Correspondence:
| | - Julien Ramillon
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
| | - Sophie Dubnitskiy-Robin
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- Inserm UMR1246 SPHERE, Universities of Nantes and Tours, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Benjamin Faivre d’Arcier
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
| | - Martine Le Verger
- Pharmacy, CHU de Tours-Trousseau, Avenue de la République, 37170 Chambray-les-Tours, France;
| | - Tanguy Le Fol
- Biomedical Unit, CHU de Tours-Trousseau, Avenue de la République, 37170 Chambray-les-Tours, France;
| | - Franck Bruyère
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
- PRES Centre Val de Loire, University of Tours, 60 Rue du Plat d’Étain, 37000 Tours, France
| | - Emmanuel Rusch
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Solène Brunet-Houdard
- Health-Economic Evaluation Unit, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (J.R.); (S.D.-R.); (E.R.); (S.B.-H.)
- EA 7505—Education Ethics Health, Faculty of Medicine, University of Tours, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Benjamin Pradère
- Department of Urology, CHU de Tours-Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France; (B.F.d.); (F.B.); (B.P.)
- Comprehensive Cancer Center, Department of Urology, Medical University of Vienna, Spitalgasse 23, 1090 Wien, Austria
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Carpenter AB, Sheppard E, Atabaki S, Shur N, Tigranyan A, Benchoff T, Snyder A, Fisher A, Cleary K. A Symposium on the Clinic of the Future and Telehealth: Highlights and Future Directions. Cureus 2021; 13:e15234. [PMID: 34178544 PMCID: PMC8223952 DOI: 10.7759/cureus.15234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children’s National Hospital held a virtual symposium on “The Clinic of the Future and Telehealth” in December 2020. The goal of the symposium was to explore future trends in these domains. We also discussed how the coronavirus disease 2019 (COVID-19) pandemic accelerated ongoing changes in healthcare. We explored what is on the horizon in these fields and how these changes might affect care delivery in the future. Specifically, we discussed the “Clinic of the Future” with clinical teams from genetics and metabolism, orthopedic surgery, and primary care while our telehealth discussion involved genetics and metabolism, psychiatry, and telerehabilitation. As one example, wearable technology could be adopted among primary care practices and drive a shift in outpatient care from center-based care to patient-based care. We also examined technological innovations in physical exam instruments, gait analysis, imaging integration, and cast technology that could modernize the orthopedic surgery clinic. Telemedicine has rapidly expanded among all fields of medicine, especially since the COVID-19 pandemic, and has spurred innovation to improve the effectiveness of virtual physician visits. The development of technology to improve the virtual physical exam, during a telemedicine visit, further increases the utility of online appointments and increases access to care in all specialties. The incorporation of photogrammetry technology, in genetics and metabolism dysmorphology exams, will offer standardized tracking of patients that could improve diagnosis and treatment. Psychiatry has found nearly equal efficacy in diagnosis and treatment with telehealth visits and the additional benefit of gaining insight in the setting of the patients’ home. Robotics has become increasingly common in rehabilitation, which can now incorporate a gaming experience that can be remotely updated and increase engagement and adherence in pediatric patients. The continued exploration of new ideas promises to improve both in-person and virtual care options.
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Affiliation(s)
- Austin B Carpenter
- Neurological Surgery, Georgetown University Medical Center, Georgetown, USA
| | - Evan Sheppard
- Orthopedics and Pediatrics, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, USA
| | - Shireen Atabaki
- Telemedicine and Emergency Medicine, Children's National Health System, Washington, USA
| | - Natasha Shur
- Genetics and Metabolism, Rare Disease Institute, Children's National Health System, Washington, USA
| | - Annie Tigranyan
- Genetics and Metabolism, Rare Disease Institute, Children's National Health System, Washington, USA
| | | | - Adam Snyder
- Anatomy, George Washington University, Washington, USA
| | - Aliza Fisher
- Medicine, Yale College, Yale University, New Haven, USA
| | - Kevin Cleary
- Medical Device Development, Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, USA
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Chung E, Jiann BP, Nagao K, Hakim L, Huang W, Lee J, Lin H, Mai DBT, Nguyen Q, Park HJ, Sato Y, Tantiwongse K, Yuan Y, Park K. COVID Pandemic Impact on Healthcare Provision and Patient Psychosocial Distress: A Multi-National Cross-Sectional Survey among Asia-Pacific Countries. World J Mens Health 2021; 39:797-803. [PMID: 34169677 PMCID: PMC8444000 DOI: 10.5534/wjmh.210033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose COVID pandemic significantly affected the delivery and maintenance of healthcare system, resulting in greater utilization of digital health interventions. Materials and Methods This multi-national cross-sectional survey was administered to clinicians working in major Asia-Pacific cities during the mandatory social lockdown period in June 2020. Clinical demographics and professional data, delivery of Andrology-related healthcare services, and patient distress based on validated questionnaires such as Depression and Anxiety Stress Scales (DASS) and Decisional Engagement Scale (DES) were collected. Results Telehealth medicine was instituted in all the centres with the majority of centres (92.9%) reported a 50% or more reduction in out-patient related services. The numbers of phone calls, emails correspondence and educational webinars have significantly increased. Despite the provision of reasons for changes in healthcare service and delay in surgery, more than half of the patients (57.1%) rated 2 on the DASS score for the item on patients over-react to situations, while a third of the patients (35.7%) scored a 2 for DASS item on patients being more demanding or unreasonable. The DES scores were more positive with most patients reported a score above 7 out of 10 in terms of items on accepting current arrangement (85.7%), confident in clinician decision-making about treatment (92.9%) and comfortable that the decision is consistent with their preferences (71.4%). Most patients (85.7%) indicated their preferences for more detailed information on healthcare provision. Conclusions Our study showed telehealth services were integrated early and successfully during the COVID pandemic and patients were generally receptive with minimal psychosocial distress.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, University of Queensland, Brisbane, QLD, Australia.,AndroUrology Centre, Macquarie University Hospital, Sydney, NSW, Australia.
| | - Bang Ping Jiann
- Department of Urology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Koichi Nagao
- Department of Urology, Toho University, Tokyo, Japan
| | - Lukman Hakim
- Department of Urology, Airlangga University, Dr Soetomo Hospital, Surabaya, Indonesia
| | - William Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Haocheng Lin
- Department of Urology and Andrology, Peking University Third Hospital, Beijing, China
| | - Dung Ba Tien Mai
- Department of Urology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Quang Nguyen
- Centre of Andrology, Department of Urology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Hyun Jun Park
- Department of Urology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Yoshikazu Sato
- Department of Urology, Sanjukai Hospital, Sapporo, Japan
| | | | - Yiming Yuan
- Andrology Centre, Peking University First Hospital, Peking University, Beijing, China
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Ficarra V, Novara G, Giannarini G, De Nunzio C, Abrate A, Bartoletti R, Crestani A, Esperto F, Galfano A, Gregori A, Liguori G, Pavan N, Simonato A, Trombetta C, Tubaro A, Porpiglia F, Scarpa RM, Mirone V. Urology practice during the COVID-19 vaccination campaign. Urologia 2021; 88:298-305. [PMID: 33983086 PMCID: PMC8127017 DOI: 10.1177/03915603211016321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction: The current scenario of the COVID-19 pandemic is significantly different from that of the first, emergency phase. Several countries in the world are experiencing a second, or even a third, wave of contagion, while awaiting the effects of mass vaccination campaigns. The aim of this report was to provide an update of previously released recommendations on prioritization and restructuring of urological activities. Methods: A large group of Italian urologists directly involved in the reorganization of their urological wards during the first and second phase of the pandemic agreed on a set of updated recommendations for current urology practice. Results: The updated recommendations included strategies for the prioritization of both surgical and outpatient activities, implementation of perioperative pathways for patients scheduled for elective surgery, management of urological conditions in infected patients. Future scenarios with possible implementation of telehealth and reshaping of clinical practice following the effects of vaccination are also discussed. Conclusion: The present update may be a valid tool to be used in the clinical practice, may provide useful recommendations for national and international urological societies, and may be a cornerstone for further discussion on the topic, also considering further evolution of the pandemic after the recently initiated mass vaccination campaigns.
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Affiliation(s)
- Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urology Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Gianluca Giannarini
- Urology Unit, "Santa Maria della Misericordia" University Hospital, Udine, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Alberto Abrate
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, Urology Unit, University of Pisa, Pisa, Italy
| | | | - Francesco Esperto
- Department of Urology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Galfano
- Urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Andrea Gregori
- Urology Unit, ASST Fatebenefratelli Sacco, Sacco Hospital, Milan, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Nicola Pavan
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Carlo Trombetta
- Department of Urology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Roma, Italy
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, School of Medicine, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | | | - Vincenzo Mirone
- Department of Urology, Federico II University of Naples, Naples, Italy
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Demirdogen SO, Cinislioglu AE, Cinislioglu N, Altay MS, Karabulut I, Polat O, Adanur S. Treatment management of COVID-19 positive patients with renal colic secondary to distal ureteral stone. Int J Clin Pract 2021; 75:e13976. [PMID: 33369824 PMCID: PMC7883115 DOI: 10.1111/ijcp.13976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE In this study, we aimed to contribute to the literature by sharing and evaluating the clinical characteristics and our treatment and follow-up approaches in patients in the COVID-19 positive treatment process who had presented to our hospital's emergency department with a distal ureteral stone and to examine the effects of the pandemic and disease in this group of patients. METHOD The study included 14 patients infected with COVID-19 who had presented to the Erzurum City Hospital Emergency Department between August 2020 and December 2020 with the complaint of renal colic in which distal ureteral stones were detected in the tests. The demographic and clinical characteristics of patients, laboratory and radiological examinations, characteristics of ureteral stones, details of treatments applied to patients, treatment procedures of patients who had undergone surgical treatment, patient files, visit and operation notes and the patient discharge reports were retrospectively reviewed and evaluated. RESULTS The study included 14 patients. The average age of the patients was 35.7 (±14.35). The average stone size was 6.2 (±1.8) mm. Analgesic treatment and MET for distal ureteral stones were begun in 11 (78.6%) of the patients. Pain control was achieved in nine patients (64.2%) with analgesic treatment and MET, and the stone was removed without invasive intervention. Surgical intervention was performed in a total of five patients (35.7%). CONCLUSION In most COVID-19 infected patients with renal colic and a distal ureteral stone, results can be obtained using MET. Patients with a distal ureteral stone and persistent renal colic can be safely and effectively treated by endoscopic ureteral stone treatment after taking necessary precautions. Prospective, randomised, and controlled studies are required on this subject.
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Affiliation(s)
- Saban Oguz Demirdogen
- Department of UrologyUniversity of Health Sciences Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Ahmet Emre Cinislioglu
- Department of UrologyUniversity of Health Sciences Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Nazan Cinislioglu
- Department of Infections Diseases and Clinical MicrobiologyUniversity of Health Sciences Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Mehmet Sefa Altay
- Department of UrologyUniversity of Health Sciences Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Ibrahim Karabulut
- Department of UrologyUniversity of Health Sciences Erzurum Regional Training and Research HospitalErzurumTurkey
| | - Ozkan Polat
- Department Of UrologyAtaturk University Medical FacultyErzurumTurkey
| | - Senol Adanur
- Department Of UrologyAtaturk University Medical FacultyErzurumTurkey
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Al-Zahrani MA, Alkhamees M, Almutairi S, Aljuhayman A, Alkhateeb S. Impact of COVID-19 on Urology Practice in Saudi Arabia. Risk Manag Healthc Policy 2021; 14:1379-1392. [PMID: 33854387 PMCID: PMC8039194 DOI: 10.2147/rmhp.s277135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/18/2021] [Indexed: 12/15/2022] Open
Abstract
From the moment the World Health Organization (WHO) declared COVID-19 to be a pandemic disease, COVID-19 began to affect the lives of many healthcare providers worldwide. In response to this pandemic, urology departments and training residency programs implemented urgent measures to reduce outpatient clinics, adopted the use of telemedicine, regulated emergency and outpatient urological procedures, promoted the use of operating theatres, and developed the use of sustainable e-learning alternatives to traditional urology educational activities. We reviewed the response of urologists in Saudi Arabia to the COVID-19 pandemic and how they react to the emerging pandemic both for patients and for healthcare of urologist personnel.
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Affiliation(s)
- Meshari A Al-Zahrani
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Mohammad Alkhamees
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Sulaiman Almutairi
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Ahmed Aljuhayman
- Department of Urology, College of Medicine, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Sultan Alkhateeb
- Department of Urology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Moussa M, Chakra MA, Papatsoris AG, Dellis A. The Impact of COVID-19 Disease on Urology Practice. Surg J (N Y) 2021; 7:e83-e91. [PMID: 34104720 PMCID: PMC8175122 DOI: 10.1055/s-0041-1725155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
The diagnosis and timely treatment of cancer patients should not be compromised during an infectious disease pandemic. The pandemic of coronavirus disease 2019 (COVID-19) has serious implications on urology practice and raises particular questions for urologists about the management of different conditions. It was recommended to cancel most of the elective urological surgeries. Urological cancers surgeries that should be prioritized are radical cystectomy for selective tumors, orchiectomy for suspected testicular tumors, nephrectomy for c T3 + , nephroureterectomy for high-grade disease, and radical adrenalectomy for tumors >6 cm or adrenal carcinoma. Most prostatectomies can be delayed without compromising the survival rate of patients. Urological emergencies should be treated adequately even during this pandemic. There is a potential risk of coronavirus diffusion during minimally invasive procedures performed. It is crucial to use specific precautions when urologists performed those type of surgeries. It was also recommended to suspend the kidney transplantation program during the COVID-19 pandemic except for specific cases. In this review, we discussed the triage of urological surgeries, the risk of minimally invasive urological procedure, the kidney transplantation challenges, the systemic therapies, intravesical instillation of Bacillus Calmette-Guérin (BCG), endourology, teleconferencing, and telemedicine application in urology during the COVID-19 pandemic.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital & Lebanese University, Beirut, Lebanon
| | | | - Athanasios G. Papatsoris
- 2nd Department of Urology, School of Medicine, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens, Greece
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
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Rassweiler JJ, Pini G, Liatsikos F, Georgiev M, Roupret M, Breda A, Knoll T, Micali S, Stenzl A, Goezen AS, Yanev K, Rassweiler-Seyfried MC. [COVID-19 in european urology : Which lessons have we learned?]. Urologe A 2021; 60:306-317. [PMID: 33559012 PMCID: PMC7869769 DOI: 10.1007/s00120-021-01450-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/30/2022]
Abstract
The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.
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Affiliation(s)
- J J Rassweiler
- Klinik für Urologie und Kinderurologie SLK Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberg, Deutschland.
- Urologische Klinik, SLK Kliniken Heilbronn, Am Gesundbrunnen 20, 74074, Heilbronn, Deutschland.
| | - G Pini
- IRCSS San Raffaele Hospital, 20132, Mailand, Lombardei, Italien
| | - F Liatsikos
- Department of Urology, University of Patras, Patras, Griechenland
| | - M Georgiev
- Department of Urology, Medical University Sofia, Sofia, Bulgarien
| | - M Roupret
- GRC 5 Predictive ONCO-URO, AP-HP, Urology, Pitié-Salpetrière Hospital, Sorbonne University, Paris, Frankreich
| | - A Breda
- Department of Uro-oncology and Transplantation, Fundacio Puigvert, Barcelona, Spanien
| | - T Knoll
- Urologische Klinik, Klinikum Sindelfingen-Böblingen, Klinikverbund-Südwest, Sindelfingen-Böblingen, Deutschland
| | - S Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italien
| | - A Stenzl
- Urologische Universitätsklinik Tübingen, Tübingen, Deutschland
| | - A S Goezen
- Klinik für Urologie und Kinderurologie SLK Kliniken Heilbronn, Akademisches Lehrkrankenhaus der Universität Heidelberg, Heidelberg, Deutschland
| | - K Yanev
- Department of Urology, Medical University Sofia, Sofia, Bulgarien
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[COVID-19 in urology : Influence of the pandemic on telemedicine, education and surgery]. Urologe A 2021; 60:301-305. [PMID: 33533961 PMCID: PMC7856848 DOI: 10.1007/s00120-021-01451-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/12/2022]
Abstract
Die COVID-19-Pandemie („coronavirus disease 2019“) hat weltweit zu wirtschaftlichen und klinischen Katastrophen geführt. In den Hochphasen mit hohen Infektionsraten verlagerte sich der klinische Alltag in den Notfallbereich und betrifft alle Fachbereiche und somit auch die Urologie. Es ist ein schmaler Grat zwischen Verschiebung einer Operation, um das Risiko einer möglichen Infektion der Patienten zu minimieren und gleichzeitig das Ergebnis der Behandlung nicht negativ zu beeinflussen. Im ambulanten Sektor konnte durch die forcierte Integration der Telemedizin die Routine kompensiert werden. Auch die Ausbildung der Urologieanwärter kann bis zu einem gewissen Punkt durch die Telemedizin aufrechterhalten werden, die operative Ausbildung fällt zunächst allerdings zurück. Das tatsächliche Ausmaß der Pandemie in der Urologie bleibt noch abzuwarten und kann erst nach Stabilisierung der Infektionswellen mit den zu erwarteten Impfstoffen erfasst werden.
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Teixeira BL, Cabral J, Mendes G, Madanelo M, Rocha MA, Mesquita S, Correia J, Tavares C, Marques-Pinto A, Fraga A. How the COVID-19 pandemic changed urology residency - a nationwide survey from the Portuguese resident's perspective. Cent European J Urol 2021; 74:121-127. [PMID: 33976927 PMCID: PMC8097653 DOI: 10.5173/ceju.2021.0278.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 01/09/2023] Open
Abstract
Introduction The aim of this article was to evaluate the impact of the COVID-19 pandemic on urology residency. Material and methods A 30 question online survey was sent to all urology residents in Portugal between the 25th of April and the 25th of May 2020. Reduction in different areas of clinical activity during the COVID-19 period were evaluated and their perceived impact on their residency program was quantified. Results Forty-three (54.4%) Portuguese urology residents responded to our inquiry. Eighty-one percent report having supressed their activity by more than 75% in the outpatient clinic; 48.8% in diagnostic procedures; 29.3% in endoscopic surgery; 67.5% in laparoscopic/robotic surgery and 17.5% in major open surgery. There were no differences in clinical activity reduction across residency years. Considering the impact of COVID-19 on urology training programs, 32.6% plan on prolonging residency. During the COVID-19 period, a larger number of residents report having spent more time developing research projects or on continuing medical education, as compared with the pre-COVID-19 period (p = 0.012). Conclusions COVID-19 had a major impact on Urology residency in Portugal, with major short- and long-term consequences. A large proportion of residents are considering prolonging their residency as a result.
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Affiliation(s)
| | - João Cabral
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Gonçalo Mendes
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Mariana Madanelo
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | | | - Sofia Mesquita
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Jorge Correia
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Catarina Tavares
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - André Marques-Pinto
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
| | - Avelino Fraga
- Centro Hospitalar Universitário do Porto, Department of Urology, Porto, Portugal
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Checcucci E, De Luca S, Alessio P, Verri P, Granato S, De Cillis S, Amparore D, Sica M, Piramide F, Piana A, Volpi G, Manfredi M, Balestra G, Autorino R, Fiori C, Porpiglia F. Implementing telemedicine for the management of benign urologic conditions: a single centre experience in Italy. World J Urol 2021; 39:3109-3115. [PMID: 33385246 PMCID: PMC7775638 DOI: 10.1007/s00345-020-03536-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/19/2020] [Indexed: 02/01/2023] Open
Abstract
Purpose To assess the use of telemedicine with phone-call visits as a practical tool to follow-up with patients affected by urological benign diseases, whose clinic visits had been cancelled during the acute phase of the COVID-19 pandemic. Methods Patients were contacted via phone-call and a specific questionnaire was administered to evaluate the health status of these patients and to identify those who needed an “in-person” ambulatory visit due to the worsening of their condition. Secondarily, the patients’ perception of a potential shift towards a “telemedicine” approach to the management of their condition and to indirectly evaluate their desire to return to “in-person” clinic visits. Results 607 were contacted by phone-call. 87.5% (531/607) of the cases showed stability of the symptoms so no clinic in-person or emergency visits were needed. 81.5% (495/607) of patients were more concerned about the risk of contagion than their urological condition. The median score for phone visit comprehensibility and ease of communication of exams was 5/5; whilst patients’ perception of phone visits’ usefulness was scored 4/5. 53% (322/607) of the interviewees didn’t own the basic supports required to be able to perform a real telemedicine consult according to the required standards. Conclusion Telemedicine approach limits the number of unnecessary accesses to medical facilities and represents an important tool for the limitation of the risk of transmission of infectious diseases, such as COVID-19. However, infrastructures, health workers and patients should reach out to a computerization process to allow a wider diffusion of more advanced forms of telemedicine, such as televisit. Electronic supplementary material The online version of this article (10.1007/s00345-020-03536-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy. .,Uro-technology and SoMe Working Group of the Young Academic Urologists (YAU) Working Party of the European Association of Urology (EAU), Arnhem, The Netherlands. .,Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy.
| | - Stefano De Luca
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Paolo Alessio
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Paolo Verri
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Stefano Granato
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Sabrina De Cillis
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Michele Sica
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Federico Piramide
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Alberto Piana
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Gabriele Volpi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Gabriella Balestra
- Department of Electronics and Telecommunications, Polytechnic University of Turin, Turin, Italy
| | | | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Turin, Italy
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