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Brument M, Defortescu G, Bugel H, Sibert L, Duflot T, Dupuis H, Surlemont L, Pfister C, Cornu JN. Differential impact of COVID-19 on urological surgeries in public and private institutions between 2019 and 2021 in France. Prog Urol 2023:S1166-7087(23)00109-4. [PMID: 37328317 PMCID: PMC10239898 DOI: 10.1016/j.purol.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The COVID-19 pandemic disrupted all routine health care services in 2020. To date, data regarding adjustment and coverage of surgical backlog in the post-COVID era actually remains scarce. The aim of this study was to compare the number of urological procedures coded between 2019 and 2021 in public and private institutions to (i) quantify the variation in surgical activity linked to the shutdown in 2020 and (ii) study the adjustment of procedures over the year 2021. MATERIALS AND METHODS This is a comprehensive retrospective analysis of all urological surgeries coded between January 1, 2019 and December 31, 2021 in France. Data were extracted from the open access dataset of the national Technical Agency for Information on Hospital Care (ATIH) website. In total, 453 urological procedures were retained and allocated in 8 categories. Primary outcome was the impact of COVID-19 analyzed by the 2020/2019 variation. The secondary outcome was the post-COVID catch-up analyzed by the 2021/2019 variation. RESULTS Surgical activity in public hospitals dropped by 13.2% in 2020 compared to 7.6% in the private sector. The most impacted areas were functional urology, stones and BPH. Incontinence surgery did not recover at all in 2021. BPH and stone surgeries were far less impacted in the private sector, with even explosive activity in 2021, post-COVID period. Onco-urology procedures were roughly maintained with a compensation in 2021 in both sectors. CONCLUSION The recovery of surgical backlog was much more efficient in the private sector in 2021. The pressure on the health system associated to the multiple COVID-19 waves may generate a gap between public and private surgical activity in the future. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- M Brument
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France.
| | - G Defortescu
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - H Bugel
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - L Sibert
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - T Duflot
- Service d'urologie, centre hospitalier de Tourcoing, 115, rue du Président-Coty, 59200 Tourcoing, France
| | - H Dupuis
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - L Surlemont
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - C Pfister
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - J-N Cornu
- Service d'urologie, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France
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Robert G, Bernhard JC, Capon G, Alezra E, Estrade V, Blanc P, Bladou F, Bensadoun H. Consequences of SARS-CoV-2 pandemic on urological surgery in France: a nationwide analysis of the healthcare system database. BMJ Open 2022; 12:e066220. [PMID: 36375970 PMCID: PMC9664026 DOI: 10.1136/bmjopen-2022-066220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The SARS-CoV-2 outbreak overwhelmed the healthcare systems worldwide. Saturation of hospitals and the risk of contagion led to a reduction in the care of other diseases. OBJECTIVE To determine the impact of SARS-CoV-2 pandemic on urological surgery in France during the year 2020. DESIGN, SETTING AND PARTICIPANTS An observational descriptive study was conducted on anonymised data collected from the national healthcare database established each year as part of the Program for the Medicalization of Information Systems in Medicine, Surgery, Obstetrics and Odontology. INTERVENTION None. PRIMARY AND SECONDARY OUTCOME MEASURES We gathered the number of urology surgical procedures carried out between 2010 and 2019, and we observed the difference between the forecast and actual number of urological surgeries performed in 2020. RESULTS Urological surgeries decreased by 11.4%, non-oncological surgeries being more affected (-13.1%) than oncological ones (-4.1%). Among the most relevant surgeries, female urinary incontinence (-44.7%) and benign prostatic hyperplasia (-20.8%) were the most impacted ones, followed by kidney cancer (-9%), urolithiasis (-8.7%), radical cystectomy for bladder cancer (-6.1%), prostate cancer (-3.6%) and transurethral resection of bladder tumour (-2%). Public hospitals had a more reduced activity (-17.7%) than private ones (-9.1%). Finally, the distribution of the reduction in urological activities by region did not correspond to the regional burden of SARS-CoV-2. CONCLUSIONS Urological care was severely affected during SARS-CoV-2 pandemic. Even if oncological surgeries were prioritised, the longer it takes to receive appropriate care, the greater the risk on survival impact. TRIAL REGISTRATION The data collection and analysis was authorised by the French Data Protection Authority (CNIL) under the number1 861 282v2.
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Affiliation(s)
- Gregoire Robert
- Department of Urology, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, Talence, France
| | | | - Grégoire Capon
- Department of Urology, CHU de Bordeaux, Bordeaux, France
| | - Eric Alezra
- Department of Urology, CHU de Bordeaux, Bordeaux, France
| | | | - Peggy Blanc
- Department of Urology, CHU de Bordeaux, Bordeaux, France
| | - Franck Bladou
- Department of Urology, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, Talence, France
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Demirci A, Hızlı F, Başar H. COVID-19 effect on perioperative findings of flexible/semi-rigid ureterorenoscopic lithotripsy: A match-pair analysis. Urologia 2022; 90:109-115. [PMID: 35445621 PMCID: PMC10076157 DOI: 10.1177/03915603221093719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE If not treated on time with proper management options, urolithiasis cause serious morphologic and functional alterations in the involved renal units. Like many other pathologies, the diagnosis, treatment, and follow-up principles of patients with urinary stones have been negatively affected by the unestimated changes in the healthcare systems dealing intensively with COVID-19 patients. In this present study, we aimed to evaluate and present the possible effects of COVID-19 infection on the ureterorenoscopic stone treatment. MATERIALS AND METHODS Clinical and procedural characteristics of 96 patients undergoing flexible and/or rigid ureterorenoscopy because of urolithiasis between March 2020 and January 2021 were evaluated in a retrospective manner. Obtained data were evaluated after match-pair analysis in a comparative manner between cases with a positive medical history of COVID-19 infection (Group 1, n: 48) and those without any COVID-19 infection (Group 2, n: 48). RESULTS There was no statistically significant difference between the two groups of cases with respect to age, gender, associated comorbidities, and stone characteristics (p > 0.05). The mean serum creatinine level was determined to be higher in Group 1 than in Group 2 (1.15 ± 0.59 mg/dl, 0.83 ± 0.21 mg/dl, p = 0.007, respectively). Evaluation of the operative parameters revealed longer mean time from diagnosis to surgery (33.5 ± 14.27 vs 12.12 ± 6.33 days, p = 0.001), operating time, median length of stay in hospital along with higher additional intervention rates, and Clavien-Dindo complication scores again in Group 1 (p < 0.05). CONCLUSION Our results indicate that the presence of COVID-19 infection anamnesis may affect the clinical and operative parameters of ureteroscopic stone management in cases with urolithiasis due to the possible effects of renal units damage and longer waiting time. Urologists may be aware of these unestimated problems during and after the intervention to take necessary measures for a safe and successful ureteroscopic stone removal.
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Affiliation(s)
- Aykut Demirci
- Department of Urology, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Fatih Hızlı
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Halil Başar
- Department of Urology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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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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Pérez Fentes D, Fernández Baltar C, Núñez Otero J, Diz Gil R, Gude Sampedro F. The SCQ-SCORE: initial validation of a new scoring system for elective stone surgery prioritization in the COVID-19 era. Cent European J Urol 2021; 74:81-88. [PMID: 33976921 PMCID: PMC8097659 DOI: 10.5173/ceju.2021.0339.r1] [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: 11/23/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 01/24/2023] Open
Abstract
Introduction Endourology waiting lists have increased during the COVID-19 pandemic and prioritization strategies are needed. Some tiered classifications have been put forward aimed at prioritizing patients by using criteria related with clinical severity or social impact of stone disease, yet no quantitative system has been published to date. The objective of this study is to present a new quantitative scoring system for elective stone surgery prioritization and show its intra- and inter-rater reliability. Material and methods A scoring system coined 'SCQ-score' was set up, which consists of 9 variables: infection (ranges 0-3), obstruction (0-3), indwelling time (0-3), admissions (0-3), symptoms (0-2), ureteral location (0-1), solitary or suboptimal kidney (0-1), chronic kidney disease (0-1) and presence of percutaneous nephrostomy (0-1).The intra- and inter-rater reliability of the SCQ-score was prospectively validated in 60 consecutive patients on the waiting list, by calculating the intraclass correlation coefficient (ICC). Results The SCQ-score demonstrated having an excellent interobserver agreement (ICC >0.75) for the final score and its different domains. After 4 weeks, a second analysis was carried out to measure its intra-rater reliability, which was also excellent. On average, 134.9 ±50 seconds were required to complete the SCQ-score. Conclusions The SCQ-score is a new quantitative system to help prioritize elective stone surgeries, which has been shown to be user-friendly and to have an excellent intra- and inter-rater reliability. Initially developed to help during the COVID-19 pandemic, its utility will probably remain of interest in the post-COVID-19 era to ensure a fairer access to stone surgery.
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Affiliation(s)
- Daniel Pérez Fentes
- University Hospital Complex of Santiago de Compostela, Endourology Unit, Department of Urology, Santiago de Compostela, Spain
| | - Carlos Fernández Baltar
- University Hospital Complex of Santiago de Compostela, Endourology Unit, Department of Urology, Santiago de Compostela, Spain
| | - Juan Núñez Otero
- University Hospital Complex of Santiago de Compostela, Endourology Unit, Department of Urology, Santiago de Compostela, Spain
| | - Rita Diz Gil
- University Hospital Complex of Santiago de Compostela, Endourology Unit, Department of Urology, Santiago de Compostela, Spain
| | - Francisco Gude Sampedro
- University Hospital Complex of Santiago de Compostela, Epidemiology Unit, Santiago de Compostela, Spain
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Abdel Raheem A, Alowidah I, Soliman M, Haresy M, Almozeni A, Althagafi S, Almousa M, Alturki M. Urolithiasis treatment options during COVID-19 pandemic: review of current recommendations and triage systems. AFRICAN JOURNAL OF UROLOGY 2020; 26:75. [PMID: 33250632 PMCID: PMC7685777 DOI: 10.1186/s12301-020-00085-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background COVID-19 pandemic has overwhelmed healthcare systems and limited access to surgical care. Urolithiasis can lead to emergencies and affect renal function during long-term follow-up. Therefore, timely and appropriate treatment is essential. Main text This is a non-systematic review of the recently published recommendations regarding urolithiasis treatment options during COVID-19. Fourteen publications were the basis of our review. Regarding anesthesia methods, the optimal methods are still unknown. During COVID-19, most of the endo-urologists changed their routine clinical practice and elective surgical treatment approaches. Despite decreasing number of emergency visits and admissions for stone disease, patients tend to have leukocytosis, higher creatinine levels, increased grade 3 and 4 hydronephrosis, and higher incidence of complications compared to non-COVID-19 time. Several alarming indications if present, intervention should be performed within 24 h to prevent irreversible kidney damage, disease progression, or even death. Some endo-urologists prefer definitive stone treatment over temporarily drainage to reduce the number of emergency room visits and hospital admissions, except if infection is present or staged treatment is planned. Several clinical scenarios of non-emergency and non-urgent urinary stones are present; thus, endo-urologists should appropriately weigh patient’s risk and surgery benefit to decide to the proper intervention time. If risks outweighed benefits to the patient, postpone the surgery. Renal colic should be managed with medical expulsive therapy and proper pain control with close follow-up just in case it becomes an emergency. Indwelling JJ stent removal or exchange is a matter of debate; some endo-urologists recommend removing, while others recommend postponing. Conclusion Treatment options for urinary stones have markedly changed during COVID-19 pandemic. The optimal anesthesia methods are still unknown. Emergency intervention is a must if any alarming indications exist. Emergency cases tend to have higher incidence of complications compared to non-COVID-19 time. For non-emergency and non-urgent urolithiasis, endo-urologists should make judicious treatment decision to prioritize urolithiasis treatment, and they should weigh benefits and risks before surgery.
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Affiliation(s)
- Ali Abdel Raheem
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt.,Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Alowidah
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohamed Soliman
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mefarrih Haresy
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali Almozeni
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan Althagafi
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohamed Almousa
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Mohamed Alturki
- Department of Urology, King Saud Medical City, Riyadh, Saudi Arabia
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