A critical review of urological practice during the coronavirus disease 2019 pandemic and the emerging role of telemedicine

Abstract

The recent coronavirus disease 2019 outbreak was met by major reconfiguration of Urology health care services with cancellation of elective surgery and deployment of non face to face models for providing outpatient care. Urologists were faced with challenging decisions to stratify their patients into risk groups for assigning the appropriate, safe method of care delivery. Guidelines were swiftly produced by Urological societies to enhance this process but there has been limited uniformity and multiple publications from several institutions. We have conducted this critical review to appraise the current recommendations for providing Urology care during the coronavirus disease 2019 pandemic. The secondary outcome was identifying novel models for care delivery. Results were presented in tables categorising the recommendation by disease and its risk stratification. Results were presented according to the aspect of care: triage for surgery, operative, post-operative and outpatient care. This review reported differing recommendations from Urological societies on the prioritisation of services with limited consideration for individual patient-related factors. Telemedicine has been utilised well during the pandemic to maintain patient pathways. The role of telemedicine in future Urological practice looks promising and more development is required. Level of evidence: Not applicable.

Emergency Urology procedures during the COVID-19 pandemic in the UK: A 3-month prospective study

“…COVID-19 affected all aspects of surgical care, from outpatient consultation to non-emergency surgery and diagnostics. [7][8][9] The pandemic affected urological practice, ranging from treatments provided to patients to the teaching opportunities available to trainees. [7][8][9][10] For acutely hospitalised non-COVID-19 patients, the aim was prompt, safe discharge as per British Association of Urological Surgeons (BAUS) recommendations.…”

“…[7][8][9] The pandemic affected urological practice, ranging from treatments provided to patients to the teaching opportunities available to trainees. [7][8][9][10] For acutely hospitalised non-COVID-19 patients, the aim was prompt, safe discharge as per British Association of Urological Surgeons (BAUS) recommendations. 9 Alterations included the earlier discharge of patients with urosepsis once parameters improved rather than proceeding with observation for 24 h. 9 During the initial lockdown, all routine appointments and diagnostic procedures were postponed and new methods of consultation were applied, that is, telephone or virtual consultations.…”

“…9 Alterations included the earlier discharge of patients with urosepsis once parameters improved rather than proceeding with observation for 24 h. 9 During the initial lockdown, all routine appointments and diagnostic procedures were postponed and new methods of consultation were applied, that is, telephone or virtual consultations. 7,[9][10][11] BAUS published alternative approaches for managing cancer. 9,12 For major uro-oncological procedures, new modifications were applied in order to maintain the continuous provision of surgical services.…”

“…7,[9][10][11] BAUS published alternative approaches for managing cancer. 9,12 For major uro-oncological procedures, new modifications were applied in order to maintain the continuous provision of surgical services. 4,13 Procedures such as cystoscopy, prostatic biopsies, and intravesical therapy for low or intermediate tumours were postponed.…”

“…11,16 Emergency surgical cases were permitted with guidelines issued to avoid laparoscopic procedures. 4,[7][8][9]17 The decision of which operative intervention to perform remained the responsibility of the Consultant Urologist. During the First wave, the decision was made by the department chair or committee of the surgical division.…”