Purpose Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. Methods Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. Results Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. Conclusion Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

Thirty patients were randomly allocated to receive either atracurium or pancuronium for neuromuscular blockade during surgery. At the end of the operation residual paralysis was antagonized with neostigmine. Voluntary strength was assessed at intervals after the antagonism, by observing grip strength, maximum inspiratory and expiratory force, 5-s head lift and the presence or absence of double vision. Grip strength and maximum expiratory force recovered significantly more quickly in the atracurium group over the 2-h measurement period. Double vision was significantly more frequent at up to 1 h when pancuronium had been used. At no time was there any significant difference between the two groups in respect of the 5-s head lift or, after 30 min, in the measurement of inspiratory force.

Forty-three mothers who had requested regional anaesthesia for elective Caesarean section were allocated randomly to receive either extradural anaesthesia with pH-adjusted 2% lignocaine with 1/200,000 adrenaline, or incremental spinal anaesthesia using a 32-gauge catheter with 0.5% plain bupivacaine. Increments of lignocaine or bupivacaine were given with the aim of achieving a block from T4 to S5. The spinal catheter was quicker to place (median 3 min, range 1-45 min, compared with median 10 min, range 1.5-50 min) and spinal anaesthesia was quicker to establish (median 20 min, range 10-46 min compared with median 48 min, range 15-59 min) compared with the extradural technique. The maximum height of the spinal block was significantly higher (median T3-4, range T5-T3) than the extradural group (median T5, range T6-T3). The total dose of intrathecal 0.5% bupivacaine was unpredictable, with a mean dose of 2.7 ml and a range between 1.5 ml and 7.4 ml. Haemodynamic stability and the quality of the block were similar between the groups. There were two mild spinal-headaches in the spinal group. All the spinal catheters were removed intact.

Twenty mothers who had requested regional analgesia during labour had a 32-gauge catheter inserted into the lumbar subarachnoid space. The mean time to place the catheters was 116 s (range 55-270 s) and there were no technical difficulties. Incremental diamorphine was given, up to a maximum initial dose of 0.5 mg. Analgesia was excellent in 11 mothers, good in seven and unsatisfactory in two. The duration of initial analgesia from diamorphine was 101 min (range 30-170 min). Eight mothers were able to move about during the first stage, with effective analgesia. Side effects were common: 15 mothers had pruritus, 15 had nausea or vomiting, and eight had mild sedation. No mother had a ventilatory frequency of less than 12 b.p.m. in the 12 h after the last dose of intrathecal diamorphine. Intrathecal 0.5% bupivacaine was given to 16 mothers in the first stage because the analgesia after a top-up with diamorphine became insufficient later in the labour. Fifteen mothers were pain free after bupivacaine; there was one failure. The initial effective dose of bupivacaine was between 0.25 ml and 2 ml. The maximum height of the block after bupivacaine was T9, and there was no hypotension. Nine mothers were given hyperbaric 0.5% bupivacaine 1-2 ml during the second stage; all were pain free for the procedure. The maximum force needed to withdraw the catheters was 700 g; and all catheters were removed intact. There were no post-spinal headaches.