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Anheuser P, Michels G, Gakis G, Neisius A, Steffens J, Kranz J. [Position paper of the working group Urological Acute Medicine]. Urologie 2023; 62:936-940. [PMID: 37115300 DOI: 10.1007/s00120-023-02090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Emergency patients with acute genitourinary system diseases are frequently encountered in both outpatient and clinical emergency structures. It is estimated that one-third of all inpatients in a urology clinic initially present as an emergency. In addition to general emergency medicine knowledge, specialized urologic expertise is a prerequisite for the care of these patients, which is needed early and specifically for optimal treatment outcomes. It must be taken into account that, on the one hand, the current structures of emergency care still lead to delays in patient care despite positive developments in recent years. On the other hand, most hospital emergency facilities need urologic expertise on site. In addition, politically intended changes in our health care system, which drive an increasing ambulantization of medicine and condition a further centralization of emergency clinics, become effective. The aim of the newly established working group "Urological Acute Medicine" is to ensure and further improve the quality of care for emergency patients with acute genitourinary system diseases and, in consensus with the German Society of Interdisciplinary Emergency and Acute Medicine, to define precise task distributions and interfaces of both specialities.
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Affiliation(s)
- Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, Alphonsstr. 14, 22403, Hamburg, Deutschland.
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland.
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Georgios Gakis
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Andreas Neisius
- Abteilung für Urologie und Kinderurologie, Krankenhaus der Barmherzigen Brüder Trier, Medizincampus der Universitätsmedizin Mainz, Trier, Deutschland
| | - Joachim Steffens
- Klinik für Urologie und Kinderurologie, St. Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Jennifer Kranz
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland
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Pogorelić Z, Milanović K, Veršić AB, Pasini M, Divković D, Pavlović O, Lučev J, Žufić V. Is there an increased incidence of orchiectomy in pediatric patients with acute testicular torsion during COVID-19 pandemic?-A retrospective multicenter study. J Pediatr Urol 2021; 17:479.e1-6. [PMID: 33994321 DOI: 10.1016/j.jpurol.2021.04.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Testicular torsion is a real emergency condition which requires prompt diagnosis and surgical management to prevent testicular loss. During the coronavirus (COVID-19) pandemic, an increased avoidance of the emergency departments for non-COVID-19 illnesses has been reported in the medical literature. OBJECTIVE The aim of this study was to investigate whether the COVID-19 pandemic caused increased number of orchiectomies in pediatric patients presenting with acute testicular torsion compared to pre-COVID-19 period. STUDY DESIGN A total number of 119 pediatric patients who underwent surgery for acute testicular torsion from January 2019 to December 2020 were enrolled in retrospective multi-center study from six institutions in Croatia. The patients were divided in two groups. The first group (pre-COVID-19) consisted of the patients who underwent surgery before COVID-19 pandemic (n = 68), while the second group (COVID-19) consisted of the patients who underwent surgery during the COVID-19 pandemic (n = 51). Main outcomes of the study were orchiectomy rates and time from onset of the symptoms to emergency department presentation. RESULTS During the COVID-19 pandemic period 43.1% (22/51) of the patients underwent orchiectomy while orchiectomy was performed in 16.2% (11/68) of the patients from the pre-COVID group (p = 0.001). Median time from onset of the symptoms to emergency department presentation during COVID-19 pandemic and pre-COVID-19 periods was 14h (IQR 5, 48) and 6h (IQR 3, 22) (p = 0.007), respectively. A higher proportion of patients waited over 24 h to present to emergency department during the COVID-19 pandemic compared to the pre-COVID-19 period (47% vs 8.8%, p = 0.007). CONCLUSION During COVID-19 pandemic a significantly higher rates of orchiectomies and increase in delayed presentations for testicular torsion was found. More patient education during pandemic in regards to management of emergency conditions such as testicular torsion is required.
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Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J, Davis-Dao CA, Ewing E, Ko J, Lee V, Macaraeg A, Nicassio L, Sadighian M, Stephany HA, Sturm R, Swords K, Wang P, Wehbi EJ, Khoury AE. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021; 17:478.e1-478.e6. [PMID: 33832873 PMCID: PMC7977032 DOI: 10.1016/j.jpurol.2021.03.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. OBJECTIVE To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. STUDY DESIGN Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. RESULTS A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). DISCUSSION We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. CONCLUSIONS In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
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Affiliation(s)
- Sarah A Holzman
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
| | - Jennifer J Ahn
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Zoe Baker
- Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kai-Wen Chuang
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Hillary L Copp
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Jacob Davidson
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Carol A Davis-Dao
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Emily Ewing
- Western University, Department of Urology, London, Ontario, Canada
| | - Joan Ko
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Victoria Lee
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Amanda Macaraeg
- University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Lauren Nicassio
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Michael Sadighian
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Heidi A Stephany
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Renea Sturm
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kelly Swords
- University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA
| | - Peter Wang
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Elias J Wehbi
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Antoine E Khoury
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
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Holzman SA, Ahn JJ, Baker Z, Chuang KW, Copp HL, Davidson J, Davis-Dao CA, Ewing E, Ko J, Lee V, Macaraeg A, Nicassio L, Sadighian M, Stephany HA, Sturm R, Swords K, Wang P, Wehbi EJ, Khoury AE. A multicenter study of acute testicular torsion in the time of COVID-19. J Pediatr Urol 2021. [PMID: 33832873 DOI: 10.16/j.jpurol.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Testicular torsion is a surgical emergency, and time to detorsion is imperative for testicular salvage. During the COVID-19 pandemic, patients may delay emergency care due to stay-at-home orders and concern of COVID-19 exposure. OBJECTIVE To assess whether emergency presentation for testicular torsion was delayed during the COVID-19 pandemic, and whether the rate of orchiectomy increased compared to a retrospective period. STUDY DESIGN Patients were prospectively enrolled in a multicenter study from seven institutions in the United States and Canada. Inclusion criteria were patients two months to 18 years of age with acute testicular torsion from March through July 2020. The retrospective group included patients from January 2019 through February 2020. Statistical analysis was performed using Kruskal-Wallis tests, Chi-square tests, and logistic regression. RESULTS A total of 221 patients were included: 84 patients in the COVID-19 cohort and 137 in the retrospective cohort. Median times from symptom onset to emergency department presentation during COVID-19 compared to the retrospective period were 17.9 h (IQR 5.5-48.0) and 7.5 h (IQR 4.0-28.0) respectively (p = 0.04). In the COVID-19 cohort, 42% of patients underwent orchiectomy compared to 29% of pre-pandemic controls (p = 0.06). During COVID-19, 46% of patients endorsed delay in presentation compared to 33% in the retrospective group (p = 0.04). DISCUSSION We found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a higher proportion of patients reported delaying care. Strengths of the study include the number of included patients and the multicenter prospective design during the pandemic. Limitations include a retrospective pre-pandemic comparison group. CONCLUSIONS In a large multicenter study we found a significantly longer time from testicular torsion symptom onset to presentation during the pandemic and a significantly higher proportion of patients reported delaying care. Based on the findings of this study, more patient education is needed on the management of testicular torsion during a pandemic.
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Affiliation(s)
- Sarah A Holzman
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA.
| | - Jennifer J Ahn
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Zoe Baker
- Children's Hospital Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kai-Wen Chuang
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Hillary L Copp
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Jacob Davidson
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Carol A Davis-Dao
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Emily Ewing
- Western University, Department of Urology, London, Ontario, Canada
| | - Joan Ko
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Victoria Lee
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Amanda Macaraeg
- University of California, Irvine, Department of Urology, Irvine, CA, USA
| | - Lauren Nicassio
- Seattle Children's, Division of Pediatric Urology, Seattle, WA, USA
| | - Michael Sadighian
- University of California, San Francisco, Department of Urology, San Francisco, CA, USA
| | - Heidi A Stephany
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Renea Sturm
- University of California, Los Angeles, Division of Pediatric Urology, Los Angeles, CA, USA
| | - Kelly Swords
- University of California, San Diego, Department of Urology, La Jolla, CA, USA; Rady Children's Hospital, Division of Pediatric Urology, San Diego, CA, USA
| | - Peter Wang
- Western University, Department of Urology, London, Ontario, Canada; Children's Hospital at London Health Sciences Centre, Division of Paediatric Surgery, London, Ontario, Canada
| | - Elias J Wehbi
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
| | - Antoine E Khoury
- University of California, Irvine, Department of Urology, Irvine, CA, USA; CHOC Children's, Division of Pediatric Urology, Orange, CA, USA
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Abstract
Urologic emergencies can involve the kidneys, ureters, bladder, urethra, penis, scrotum, or testicles. History and physical examination are essential to diagnosis, whereas imaging is increasingly used to confirm diagnoses. Acute urinary retention should be relieved with Foley placement. Penile emergencies include paraphimosis, which can be treated by foreskin reduction, whereas penile fracture and priapism require urologic intervention. Fournier gangrene and testicular torsion are scrotal emergencies requiring emergent surgery. Nephrolithiasis, although painful, is not an emergency unless there is concern for concomitant urinary tract infection, both ureters are obstructed by stones, or there is an obstructing stone in a solitary kidney.
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Affiliation(s)
- Adarsh S Manjunath
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA
| | - Matthias D Hofer
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue 16-703, Chicago, IL 60611, USA.
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Abstract
The diagnosis and management of urologic emergencies are incorporated into the basic training of all urology residents. In institutions without access to urologic services, it is usually left to the General Surgeon or Emergency Medicine physician to provide timely care. This article discusses diagnoses that are important to recognize and treatment that is practically meaningful for the non-Urologist to identify and treat. The non-Urology provider, after reading this article, will have a better understanding and a higher comfort level with treating patients with urologic emergencies.
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Affiliation(s)
- Adam E Ludvigson
- Division of Urology, Maine Medical Center, 100 Brickhill Ave., South Portland, Maine 04106, USA
| | - Lisa T Beaule
- Division of Urology, Maine Medical Center, Tufts University School of Medicine, 100 Brickhill Ave., South Portland, Maine 04106, USA.
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