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Pediatric urology in the era of COVID-19. JOURNAL OF PEDIATRIC ENDOSCOPIC SURGERY 2021. [PMCID: PMC7920845 DOI: 10.1007/s42804-021-00097-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction The coronavirus disease 2019 (COVID-19) has mandated the pediatric urologists to adapt to the changing dynamics and adopt the strategy to minimise the collateral damage. The purpose of this study is to compile all the available literature and published guideline to facilitate the patient management. Materials and methods PubMed, Scopus, and Google scholar database were systematically searched using the search terms “COVID-19” AND “pediatric” AND “urology”. All published papers retrieved from this search were considered for this review based on PRISMA guidelines. In addition to this, World Wide Web search was conducted for guidelines, and recommendations published by scientific societies and their websites were searched for the desired information. Results Total eight articles and society recommendations met the inclusion criteria and included in the study. The general level of agreement was found on need to postpone the elective cases and ensuring the safety of hospital staff. The organ and life-threatening conditions like acute and symptomatic obstructive uropathy and testicular torsion should be treated on an emergent basis irrespective of COVID status. There is no evidence that any modality either open or laparoscopic has any advantage over the other. The protocols need to be modified based on stage of pandemic, availability of resources, and local guidelines. The restart of work once the pandemic is over should also be prioritised. Conclusion There are very few articles and society guidelines on pediatric urology care in the COVID era, but all the available guidelines stress on prioritisation, protocol-based management, and improvisation as per the circumstances. Level of evidence V.
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Farooq MAA, Kabir SMH, Chowdhury TK, Sadia A, Alam MA, Farhad T. Changes in children's surgical services during the COVID-19 pandemic at a tertiary-level government hospital in a lower middle-income country. BMJ Paediatr Open 2021; 5:e001066. [PMID: 34192202 PMCID: PMC8015790 DOI: 10.1136/bmjpo-2021-001066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/27/2021] [Accepted: 03/20/2021] [Indexed: 11/04/2022] Open
Abstract
Objective The aim of this study was to quantify the changes that occurred in the surgical services of children during the COVID-19 pandemic from the perspective of a low/middle-income country. Design A case-control study was conducted at a large referral centre in Bangladesh among patients aged ≤12 years. Comparisons were made between cases admitted during a period of 'April to September 2020' (Pandemic period) and controls during a similar period in 2019 (Reference period). The number of admissions and outpatient department (OPD) attendances, age and sex distribution, diagnosis, number and types of surgeries performed (elective vs emergency), variations in treatment of acute appendicitis, types of anaesthesia and mortality were compared. Results Admissions were only 41% of previous year (635 vs 1549), and OPD attendances were only 28% of previous year (603 vs 2152). Admission of children reduced by 65.8%, but neonatal admission reduced only by 7.6%. The median age of the admitted patients was significantly lower during the pandemic period (3 vs 4 years, p<0.01). Acute appendicitis (151, 9.8%) and trauma (61, 9.6%), respectively, were the the most common causes of admission during the reference and the pandemic period. Elective surgeries were only 17% and emergency surgeries were 64% of previous year (p<0.01). Appendectomy (88, 9.1%) and laparotomy (77, 17.6%), respectively, were the most common surgeries performed during the reference and the pandemic period. Conservative treatment of acute appendicitis was more during the pandemic period (47.5% vs 28.5%, p=0.01), but patients who underwent appendectomies had more complicated appendicitis (63.3% vs 42.1%, p=0.01). In all, 90.4% of surgeries were performed by resident doctors. There were no COVID-19- related deaths. Conclusion Trauma became the most common cause of admission during the pandemic, and neonatal surgical conditions remained almost unchanged with high mortality rates. Elective procedures and laparoscopy remained low and resident doctors played a major role in providing surgical services.
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Affiliation(s)
| | - S M Humayun Kabir
- Director, Chattogram Medical College Hospital, Chattogram, Bangladesh
| | | | - Ayesha Sadia
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Md. Afruzul Alam
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
| | - Tanzil Farhad
- Department of Paediatric Surgery, Chittagong Medical College, Chattogram, Bangladesh
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Lee MJ, Koven AB, Chua ME, Koyle MA. Case - Incorporating modern technology with traditional ceremony of Brit Milah during the COVID-19 pandemic. Can Urol Assoc J 2021; 15:E187-E188. [PMID: 33688822 DOI: 10.5489/cuaj.7120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Min Joon Lee
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Alexander B Koven
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, NCR, Phillipines
| | - Martin A Koyle
- Division of Urology, Department of Surgery, University of Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, Toronto, ON, Canada
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O'Kelly F, Sparks S, Seideman C, Gargollo P, Granberg C, Ko J, Malhotra N, Hecht S, Swords K, Rowe C, Whittam B, Spinoit AF, Dudley A, Ellison J, Chu D, Routh J, Cannon G, Kokorowski P, Koyle M, Silay MS. A survey and panel discussion of the effects of the COVID-19 pandemic on paediatric urological productivity, guideline adherence and provider stress. J Pediatr Urol 2020; 16:492.e1-492.e9. [PMID: 32680626 PMCID: PMC7334656 DOI: 10.1016/j.jpurol.2020.06.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/12/2020] [Accepted: 06/19/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The COVID-19 pandemic has led to an unprecedented need to re-organise and re-align priorities for all surgical specialties. Despite the current declining numbers globally, the direct effects of the pandemic on institutional practices and on personal stress and coping mechanisms remains unknown. The aims of this study were to assess the effect of the pandemic on daily scheduling and work balances, its effects on stress, and to determine compliance with guidelines and to assess whether quarantining has led to other areas of increased productivity. METHODS A trans-Atlantic convenience sample of paediatric urologists was created in which panellists (Zoom) discussed the direct effects of the COVID-19 pandemic on individual units, as well as creating a questionnaire using a mini-Delphi method to provide current semi-quantitative data regarding practice, and adherence levels to recently published risk stratification guidelines. They also filled out a Perceived Stress Scale (PSS) questionnaire to assess contemporary pandemic stress levels. RESULTS There was an 86% response rate from paediatric urologists. The majority of respondents reported near complete disruption to planned operations (70%), and trainee education (70%). They were also worried about the effects of altered home-lives on productivity (≤90%), as well as a lack of personal protective equipment (57%). The baseline stress rate was measured at a very high level (PSS) during the pandemic. Adherence to recent operative guidelines for urgent cases was 100%. CONCLUSION This study represents a panel discussion of a number of practical implications for paediatric urologists, and is one of the few papers to assess more pragmatic effects and combines opinions from both sides of the Atlantic. The impact of the pandemic has been very significant for paediatric urologists and includes a decrease in the number of patients seen and operated on, decreased salary, increased self-reported stress levels, substantially increased telemedicine usage, increased free time for various activities, and good compliance with guidelines and hospital management decisions.
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Affiliation(s)
- Fardod O'Kelly
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada.
| | - Scott Sparks
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Casey Seideman
- Division of Pediatric Urology, OHSU Doernbecher Children's Hospital, Portland, OR, USA
| | | | | | - Joan Ko
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | | | - Sarah Hecht
- Division of Pediatric Urology, Children's Hospital Colorado, USA
| | - Kelly Swords
- Division of Pediatric Urology, Rady Children's Hospital, San Diego, CA, USA
| | - Courtney Rowe
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | - Ben Whittam
- Division of Pediatric Urology, Riley Children's, Indianapolis, IN, USA
| | | | - Anne Dudley
- Division of Pediatric Urology, Connecticut Children's Hospital, USA
| | | | - David Chu
- Division of Pediatric Urology, Lurie Children's Chicago, IL, USA
| | - Jonathan Routh
- Division of Urologic Surgery, Duke University Medical Centre, NC, USA
| | - Glenn Cannon
- Division of Pediatric Urology, University of Pittsburgh Medical Centre, PA, USA
| | - Paul Kokorowski
- Division of Pediatric Urology, Children's Hospital of Los Angeles, CA, USA
| | - Martin Koyle
- Division of Paediatric Urology, The Hospital for Sick Children, Toronto, Canada
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