The dramatic COVID 19 outbreak in Italy is responsible of a huge drop of urological surgical activity: a multicenter observational study

Objective

To describe the trend in surgical volume in urology in Italy during the coronavirus disease 2019 (COVID‐19) outbreak, as a result of the abrupt reorganisation of the Italian national health system to augment care provision to symptomatic patients with COVID‐19.

Methods

A total of 33 urological units with physicians affiliated to the AGILE consortium (Italian Group for Advanced Laparo‐Endoscopic Surgery; www.agilegroup.it) were surveyed. Urologists were asked to report the amount of surgical elective procedures week‐by‐week, from the beginning of the emergency to the following month.

Results

The 33 hospitals involved in the study account overall for 22 945 beds and are distributed in 13/20 Italian regions. Before the outbreak, the involved urology units performed overall 1213 procedures/week, half of which were oncological. A month later, the number of surgeries had declined by 78%. Lombardy, the first region with positive COVID‐19 cases, experienced a 94% reduction. The decrease in oncological and non‐oncological surgical activity was 35.9% and 89%, respectively. The trend of the decline showed a delay of roughly 2 weeks for the other regions.

Conclusion

Italy, a country with a high fatality rate from COVID‐19, experienced a sudden decline in surgical activity. This decline was inversely related to the increase in COVID‐19 care, with potential harm particularly in the oncological field. The Italian experience may be helpful for future surgical pre‐planning in other countries not so drastically affected by the disease to date.

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy.

MATERIALS AND METHODS

A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes.

RESULTS

Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05).

CONCLUSION

In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

Urology in the Time of Coronavirus: Reduced Access to Urgent and Emergent Urological Care during the Coronavirus Disease 2019 Outbreak in Italy

PURPOSE

The coronavirus disease 2019 (COVID-19) pandemic has put a substantial burden on the Italian healthcare system, resulting in the restructuring of hospitals to care for COVID-19 patients. However, this has likely impacted access to care for patients experiencing other conditions. We aimed to quantify the impact of COVID-19 on access to care for patients with urgent/emergent urological conditions throughout Italy.

MATERIALS AND METHODS

A questionnaire was sent to 33 urological units in the AGILE consortium, asking clinicians to report on the number of urgent/emergent urological patients seen and/or undergoing surgery over a 3-week period during the peak of the COVID-19 outbreak and a reference week prior to the outbreak. ANOVA and linear regression models were used to quantify these changes.

RESULTS

Data from 27 urological centres in Italy showed a decrease from 956 patients/week seen just prior to the outbreak to 291 patients/week seen by the end of the study period. There was a difference in the number of patients with urgent/emergent urological disease seen within/during the different weeks (all p values < 0.05). A significant decrease in the number of patients presenting with haematuria, urinary retention, urinary tract infection, scrotal pain, renal colic, or trauma and urgent/emergent cases that required surgery was reported (all p values < 0.05).

CONCLUSION

In Italy, during the COVID-19 outbreak there has been a decrease in patients seeking help for urgent/emergent urological conditions. Restructuring of hospitals and clinics is mandatory to cope with the COVID-19 pandemic; however, the healthcare system should continue to provide adequate levels of care also to patients with other conditions.

Classification of Histologic Patterns of Pseudocapsular Invasion in Organ-Confined Renal Cell Carcinoma

A standardized histologic definition and classification of the patterns of renal tumor pseudocapsular invasion (RTPI) in renal cell carcinoma (RCC) is not available. We classified RTPI into 2 main histologic patterns: expansive and infiltrative RTPI. Patients with organ-confined RCC and infiltrative RTPI had a greater risk of cancer-specific death and might require stricter postoperative surveillance strategies.

INTRODUCTION

A standardized histologic definition and classification of patterns of renal tumor pseudocapsular invasion (RTPI) in renal cell carcinoma (RCC) is not available. The aim of the present study was to propose a classification of RTPI patterns and assess their correlation with other pathologic features and prognosis.

PATIENTS AND METHODS

The renal tumor pseudocapsule was assessed by 2 expert genitourinary pathologists on the histologic slides of 190 specimens from radical nephrectomy performed for organ-confined (pT1-pT2) RCC. The histologic patterns of RTPI were classified and described. The association between the RTPI patterns and other pathologic features was assessed. The Kaplan-Meier method was used to calculate the survival functions, and Cox regression models were used to assess the predictors of cancer-specific survival.

RESULTS

RTPI was classified into 2 main histologic patterns (expansive and infiltrative). Expansive and infiltrative RTPI was observed in 39.5% and 51.6% of cases, respectively. A significant association between the RTPI pattern and Fuhrman grade (P = .006) and RCC histologic subtype (P = .034) was detected. Patients with infiltrative pseudocapsular invasion had significantly poorer 5- and 10-year cancer-specific survival rates than patients with expansive invasion or no invasion (93.6% vs. 98.9% and 84.9% vs. 93%, respectively; P = .039). The presence of infiltrative pseudocapsular invasion was a significant predictor of cancer-specific survival (hazard ratio 4.38, 95% confidence interval 1.04-20.27).

CONCLUSION

An expansive and an infiltrative RTPI pattern can be described. In our study, patients with organ-confined RCC and an infiltrative RTPI pattern had a greater risk of cancer-specific death and might require stricter postoperative surveillance strategies.