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Li KD, Chu CE, Patel M, Meng MV, Morgan TM, Porten SP. Cxbladder Monitor testing to reduce cystoscopy frequency in patients with bladder cancer. Urol Oncol 2023; 41:326.e1-326.e8. [PMID: 36868882 DOI: 10.1016/j.urolonc.2023.01.009] [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: 11/22/2022] [Revised: 01/04/2023] [Accepted: 01/12/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Bladder cancer surveillance is associated with high costs and patient burden. CxMonitor (CxM), a home urine test, allows patients to skip their scheduled surveillance cystoscopy if CxM-negative indicating a low probability of cancer presence. We present outcomes from a prospective multi-institutional study of CxM to reduce surveillance frequency during the coronavirus pandemic. MATERIALS AND METHODS Eligible patients due for cystoscopy from March-June 2020 were offered CxM and skipped their scheduled cystoscopy if CxM-negative. CxM-positive patients came for immediate cystoscopy. The primary outcome was safety of CxM-based management, assessed by frequency of skipped cystoscopies and detection of cancer at immediate or next cystoscopy. Patients were surveyed on satisfaction and costs. RESULTS During the study period, 92 patients received CxM and did not differ in demographics nor history of smoking/radiation between sites. 9 of 24 (37.5%) CxM-positive patients had 1 T0, 2 Ta, 2 Tis, 2 T2, and 1 Upper tract urothelial carcinoma (UTUC) on immediate cystoscopy and subsequent evaluation. 66 CxM-negative patients skipped cystoscopy, and none had findings on follow-up cystoscopy requiring biopsy. Six of these patients did not attend follow-up, 4 elected to undergo additional CxM instead of cystoscopy, 2 stopped surveillance, and 2 died of unrelated causes. CxM-negative and positive patients did not differ in demographics, cancer history, initial tumor grade/stage, AUA risk group, or number of prior recurrences. Median satisfaction (5/5, IQR 4-5) and costs (26/33, 78.8% no out-of-pocket costs) were favorable. CONCLUSIONS CxM safely reduces frequency of surveillance cystoscopy in real-world settings and appears acceptable to patients as an at-home test.
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Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Carissa E Chu
- Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Milan Patel
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Maxwell V Meng
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Sima P Porten
- Department of Urology, University of California San Francisco, San Francisco, CA.
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Patel A, Dzioba A, Hong P, Husein M, Strychowsky J, You P, Paradis J, Graham M. Changes to the practice of pediatric otolaryngology as a consequence of the COVID-19 pandemic. Int J Pediatr Otorhinolaryngol 2022; 153:111021. [PMID: 34990923 PMCID: PMC8720179 DOI: 10.1016/j.ijporl.2021.111021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has shifted medical practice globally. The objective of this study was to examine the changes to the practice of pediatric otolaryngology internationally due to the COVID-19 pandemic and examine potential contributors. METHOD An online survey was designed to assess practice demographics, patterns of COVID-19 related restrictions in communities, and changes to practice and referrals. This was disseminated via an international Covid-19 WhatsApp™ group of pediatric otolaryngologists. RESULTS There were 45 respondents of 177 group members (25.4%) from 15 countries. The mean estimated time spent under strictest lockdown measures was 16.2 (±10.7) weeks (range: 1-45 weeks). Operating room time was reduced for 82.9%, with an average reported reduction of 41.5%. Almost all (>75%) of respondents reported reduced referrals for five common conditions: otitis media with effusion (average reported decrease - 56.1%); acute otitis media (average decrease 62.8%); acute mastoiditis (average decrease 66.6%); recurrent pharyngotonsillitis (average decrease 51.0%); and peritonsillar abscess (average decrease 52.1%). COVID-19 cases per million population significantly influenced the acuity of referrals received (p < .05). No conditions were reported as increased in frequency and the acuity of most conditions was reported as unchanged by the majority of respondents. CONCLUSION The measures taken to reduce the spread of COVID-19 have resulted in many changes to pediatric otolaryngology practice and the referral patterns of common conditions. Some of these changes may have enduring sequelae.
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Affiliation(s)
- Ashaka Patel
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1.
| | - Agnieszka Dzioba
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada.
| | - Paul Hong
- Dalhousie University and IWK Health Centre, 5980 University Ave #5850, Halifax, Nova Scotia, Canada, B3K 6R8.
| | - Murad Husein
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada.
| | - Julie Strychowsky
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada.
| | - Peng You
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada.
| | - Josee Paradis
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1; Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada.
| | - M.E. Graham
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, Canada, N6A 5C1,Department of Otolaryngology – Head and Neck Surgery, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, Canada,Corresponding author. Victoria Hospital, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
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Alonso-Isa M, García-Gómez B, García-Rojo E, Medina-Polo J, Manfredi C, Rodríguez-Antolín A, Romero-Otero J. [Penile prosthesis implantation in the covid era. post-surgery follow up and management of complications]. Rev Int Androl 2021; 20:62-67. [PMID: 34303628 PMCID: PMC8295190 DOI: 10.1016/j.androl.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To provide recommendations regarding surgery, follow-up, and management of possible complications related to penile prostheses implantation, during the COVID-19 pandemic. MATERIAL AND METHODS We designed a critical narrative review of the studies investigating the impact of COVID-19 on urology practice and on penile prosthetic implantology. A comprehensive search in the MEDLINE database was performed. Different combinations of the following keywords were used according to a free-text protocol:: "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery", "penile prostheses". Papers in English and Spanish language, published until September 2020 were included in the review. RESULTS Penile prosthesis implantation is an elective surgery which should always be deferred when it cannot be performed in maximum safety conditions. However, it may lead to complications wich must be resolved urgently even within the COVID-19 Era. CONCLUSIONS Currently, it is mandatory to develop shared strategies to avoid potential COVID-19-related complications for surgical patients. Penile prosthesis implantation should be deferred to avoid unnecessary risks and all preventive measures should be taken to minimize the risks in the event of non-delayable surgery.
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Affiliation(s)
- Manuel Alonso-Isa
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España.
| | - Borja García-Gómez
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
| | - Esther García-Rojo
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - José Medina-Polo
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
| | - Celeste Manfredi
- Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España; Unidas of Urología, Universidad de Campania Luigi Vanvitelli, Nápoles, Italia
| | - Alfredo Rodríguez-Antolín
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España
| | - Javier Romero-Otero
- Departmento de Urología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, España; Hospital Universitario HM Puerta del Sur, Móstoles, Madrid, España; Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, España
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Serretta V, Berardinis ED, Simonato A, Guarneri A, Dispensa N, Pavone C, Busetto GM, Del Giudice F, Sanfilippo C. A prospective observational study on oral administration of Ellagic Acid and Annona Muricata in patients affected by non-muscle invasive bladder cancer not undergoing maintenance after 6-week intravesical prophylaxis. Urologia 2021; 89:49-52. [PMID: 34075841 DOI: 10.1177/03915603211022285] [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] [Indexed: 11/15/2022]
Abstract
INTRODUCTION BCG and MMC shortage and Covid-19 pandemic, more recently, limit accessibility to maintenance regimen in intravesical prophylaxis against recurrence of non-muscle invasive bladder cancer (NMIBC). Ellagic acid (EA) and Annona muricata (AM) exert antitumor activity against different human tumours. An observational prospective study on the prophylactic effect of oral administration of EA+AM in patients avoiding maintenance regimen is presented. MATERIALS AND METHODS Patients affected by NMIBC and not undergoing maintenance after a 6-week course of intravesical prophylaxis with MMC or BCG were entered. Tis and very high-risk tumours were excluded. After informed consent, the patients were subdivided in relation to the oral assumption or not of EA (100 mg) plus AM (100 mg), daily for 6 months. All patients were submitted to 3-month cytology and cystoscopy. RESULTS 162 (90%) of 180 entered patients are evaluable, 90 and 72 receiving or not EA+AM. No difference emerged in patients' characteristics between the two groups. BCG was given in 86 (54%) and chemotherapy in 74 (46%) patients. The recurrence free rate at 3, 6 and 12 months in patients assuming or not EA was 96.5% versus 84.6% (p = 0.003), 85.4% versus 64.8% (p = 0.005) and 74.2% versus 60.6% (p = 0.246), respectively. The recurrence free survival at 12 months in patients assuming or not EA was 63.0% versus 34.5% (p < 0.0001). DISCUSSION AND CONCLUSIONS Our study suffers several limits: not randomized trial although prospective, limited number of patients and short follow-up, nevertheless it shows the prophylactic effect of oral EA+AM in absence of maintenance after intravesical chemotherapy or immunotherapy induction.
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Affiliation(s)
- Vincenzo Serretta
- Urology Unit, Department of Surgical, Oncological and Oral Sciences University of Palermo, Palermo, Italy
| | | | - Alchiede Simonato
- Urology Unit, Department of Surgical, Oncological and Oral Sciences University of Palermo, Palermo, Italy
| | - Alessio Guarneri
- Urology Unit, Department of Surgical, Oncological and Oral Sciences University of Palermo, Palermo, Italy
| | - Nino Dispensa
- Urology Unit, Department of Surgical, Oncological and Oral Sciences University of Palermo, Palermo, Italy
| | - Carlo Pavone
- Urology Unit, Department of Surgical, Oncological and Oral Sciences University of Palermo, Palermo, Italy
| | - Gian Maria Busetto
- Urology Unit, Sapienza Rome University, Policlinico Umberto I, Roma, Italy
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Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the post-COVID-19 era. ACTAS UROLÓGICAS ESPAÑOLAS (ENGLISH EDITION) 2021. [PMCID: PMC7946567 DOI: 10.1016/j.acuroe.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Introduction Methods Results Conclusions
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García-Rojo E, Manfredi C, Santos-Pérez-de-la-Blanca R, Tejido-Sánchez Á, García-Gómez B, Aliaga-Benítez M, Romero-Otero J, Rodriguez-Antolín A. [Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era]. Actas Urol Esp 2021; 45:207-214. [PMID: 34017152 PMCID: PMC7648495 DOI: 10.1016/j.acuro.2020.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/28/2020] [Accepted: 11/03/2020] [Indexed: 12/11/2022]
Abstract
Introduction The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. Methods An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. Results A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). Conclusions The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.
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Affiliation(s)
- E García-Rojo
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - C Manfredi
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
- Departamento de Cirugía de la Mujer, el Niño y Cirugía General y Especializada, Universidad de Campania «Luigi Vanvitelli», Nápoles, Italia
| | | | - Á Tejido-Sánchez
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - B García-Gómez
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - M Aliaga-Benítez
- Servicio de Admisión y Documentación Clínica, Hospital 12 de Octubre, Madrid, España
| | - J Romero-Otero
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
| | - A Rodriguez-Antolín
- Servicio de Urología, Instituto de Investigación Sanitaria (imas12), Hospital 12 de Octubre, Madrid, España
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Bozkurt O, Sen V, Irer B, Sagnak L, Onal B, Tanidir Y, Karabay E, Kaya C, Ceyhan E, Baser A, Duran MB, Suer E, Celen I, Selvi I, Ucer O, Karakoc S, Sarikaya E, Ozden E, Deger D, Egriboyun S, Ongun S, Gurboga O, Asutay MK, Kazaz IO, Yilmaz IO, Kisa E, Demirkiran ED, Horsanali O, Akarken I, Kizer O, Eren H, Ucar M, Cebeci OO, Kizilay F, Comez K, Mercimek MN, Ozkent MS, Izol V, Gudeloglu A, Ozturk B, Akbaba KT, Polat S, Gucuk A, Ziyan A, Selcuk B, Akdeniz F, Turgut H, Sabuncu K, Kaygisiz O, Ersahin V, Kahraman HI, Guzelsoy M, Demir O. Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey. Int J Clin Pract 2021; 75:e13735. [PMID: 32996259 PMCID: PMC7536952 DOI: 10.1111/ijcp.13735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. METHODOLOGY The centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. The number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. The weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. RESULTS A total of 51 centres participated in the study. The number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. CONCLUSIONS Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines.
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Gomes CM, Favorito LA, Henriques JVT, Canalini AF, Anzolch KMJ, de Carvalho Fernandes R, Bellucci CHS, Silva CS, Wroclawski ML, Pompeo ACL, de Bessa J. Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists. Int Braz J Urol 2020; 46:1042-1071. [PMID: 32539253 PMCID: PMC7527096 DOI: 10.1590/s1677-5538.ibju.2020.99.15] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. MATERIALS AND METHODS A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. RESULTS Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and non-essential surgeries (OR=2.95, 95% CI 1.86 - 4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). CONCLUSIONS COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.
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Affiliation(s)
- Cristiano M Gomes
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Luciano A Favorito
- Unidade de Pesquisa Urogenital, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - João Victor T Henriques
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alfredo F Canalini
- Divisão de Urologia, Universidade Estadual do Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil
| | - Karin M J Anzolch
- Departamento de Urologia, Hospital Moinhos de Vento, Porto Alegre, RS, Brasil
| | | | - Carlos H S Bellucci
- Divisão de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Caroline S Silva
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
| | - Marcelo L Wroclawski
- Departamento de Urologia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
- Departamento de Urologia, Beneficência Portuguesa de São Paulo, São Paulo, SP, Brasil
| | | | - José de Bessa
- Departamento de Saúde Pública e Epidemiologia, Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brasil
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Re: Roman Sosnowski, Hubert Kamecki, Steven Joniau, Jochen Walz, Zachary Klaassen, Joan Palou. Introduction of Telemedicine During the COVID-19 Pandemic: A Challenge for Now, an Opportunity for the Future. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.07.007. Eur Urol 2020; 79:e26-e27. [PMID: 33077304 PMCID: PMC7567662 DOI: 10.1016/j.eururo.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
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Dotzauer R, Böhm K, Brandt MP, Sparwasser P, Haack M, Frees SK, Kamal MM, Mager R, Jäger W, Höfner T, Tsaur I, Haferkamp A, Borgmann H. Global change of surgical and oncological clinical practice in urology during early COVID-19 pandemic. World J Urol 2020; 39:3139-3145. [PMID: 32623500 PMCID: PMC7335229 DOI: 10.1007/s00345-020-03333-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/29/2022] Open
Abstract
Objectives While the coronavirus disease 2019 (COVID-19) pandemic captures healthcare resources worldwide, data on the impact of prioritization strategies in urology during pandemic are absent. We aimed to quantitatively assess the global change in surgical and oncological clinical practice in the early COVID-19 pandemic. Methods In this cross-sectional observational study, we designed a 12-item online survey on the global effects of the COVID-19 pandemic on clinical practice in urology. Demographic survey data, change of clinical practice, current performance of procedures, and current commencement of treatment for 5 conditions in medical urological oncology were evaluated. Results 235 urologists from 44 countries responded. Out of them, 93% indicated a change of clinical practice due to COVID-19. In a 4-tiered surgery down-escalation scheme, 44% reported to make first cancellations, 23% secondary cancellations, 20% last cancellations and 13% emergency cases only. Oncological surgeries had low cancellation rates (%): transurethral resection of bladder tumor (27%), radical cystectomy (21–24%), nephroureterectomy (21%), radical nephrectomy (18%), and radical orchiectomy (8%). (Neo)adjuvant/palliative treatment is currently not started by more than half of the urologists. COVID-19 high-risk-countries had higher total cancellation rates for non-oncological procedures (78% vs. 68%, p = 0.01) and were performing oncological treatment for metastatic diseases at a lower rate (35% vs. 48%, p = 0.02). Conclusion The COVID-19 pandemic has affected clinical practice of 93% of urologists worldwide. The impact of implementing surgical prioritization protocols with moderate cancellation rates for oncological surgeries and delay or reduction in (neo)adjuvant/palliative treatment will have to be evaluated after the pandemic. Electronic supplementary material The online version of this article (10.1007/s00345-020-03333-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert Dotzauer
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Katharina Böhm
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Maximilian Peter Brandt
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Peter Sparwasser
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Maximilian Haack
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Sebastian. Karl Frees
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mohamed Mostafa Kamal
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - René Mager
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Wolfgang Jäger
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Thomas Höfner
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Igor Tsaur
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Hendrik Borgmann
- Department of Urology, University Medical Center, Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz, Germany
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