Cómo la pandemia por COVID-19 ha cambiado la forma de atender a las pacientes en una unidad de uroginecología

Impact of COVID-19 on management of urogynaecology patients: a rapid review of the literature

“…How much can telemedicine be useful during and after the COVID-19 pandemic? Systematic review Telemedicine 12/12 Management of lower urinary tract symptoms [ 8 ] 23 June COVID-19 and gynecological cancer: a review of the published guidelines Review Reducing horizontal transmission 11/12 Surgical prioritisation Outpatient clinics Inpatient admissions [ 24 ] 9 July Triaging office based urology procedures during the COVID-19 pandemic Recommendations Outpatient procedures [ 25 ] 25 August How did COVID-19 pandemic change the way we attend the patients in an urogynaecological unit Review Assessment and management of lower urinary tract symptoms 9/12 Management of prolapse Surgical prioritisation Telemedicine [ 26 ] 2 September A lasting impression: telemedicine in urogynecology during the coronavirus disease 2019 pandemic Review Telemedicine 10/12 [ 27 ] 15 September A systematic review on guidelines and recommendations for urology standard of care during the COVID-19 pandemic Review Uro-oncology 12/12 Endoscopic and robotic surgery Outpatient procedures [ 28 ] 15 September Management of female and functional urology patients during the COVID pandemic Review Surgical prioritisation 11/12 Surgical techniques to minimise exposure Management of lower urinary tract symptoms [ 29 ...…”

“…weight loss, Kegel exercises, PFMT Short-term antimuscarinic unlikely to cause dementia therefore can use in elderly if required Smart phone apps, e.g. for Kegel training Home biofeedback devices Pessaries: encourage self-cleaning at home Can safely delay change up to 6 months Consider vaginal oestrogen and empiric treatment for bacterial vaginosis If bleeding/discharge can remove and observe for voiding dysfunction prior to clinic review [ 3 ] Initial virtual consultations Initial virtual consultations Can commence treatment remotely Procidentia causing bowel/urinary problems need early review within 30 days Provide patients with information resources Pessaries: face-to-face review within 7 days if symptoms suggestive of fistulation Pessaries: face-to-face review within 30 days if bleeding/pain/ulceration Pessaries: refer via local PMB cancer pathway if PMB with pessary and uterus in situ Ring pessaries: can defer change up to 6 months Shaatz, shelf, Gelhorn, double pessaries: defer for a maximum of 3 months Patients to be given contact numbers in the case of symptoms of ulceration [ 16 ] Encourage conservative and medical treatments Virtual clinics SUI: all new patients with signs of retention and overflow, see face-to-face for PVR with external probe If grade 4 prolapse, consider US KUB Favour pessary management Consider surgery if stage 4 prolapse, failed pessaries and obstructive renal failure [ 26 ] Non-surgical options as first line whilst elective surgeries restricted Non-surgical options as first line whilst elective surgeries are restricted Medication management Smart phone apps Smart phone apps [ 25 ] Start all UI consultations using telemedicine Supplement with use of mobile apps Conservative measures—weight loss, bladder training, PFMT, Kegel exercises ± medications [ 36 ] Prescribe ...…”

“…Urinary tract infections can be managed via virtual consultation [ 17 , 19 , 23 , 25 ]. If the patient has recurrent UTIs conservative measures and non-antibiotic therapies should be encouraged [ 17 ].…”

“…cranberry, hydration, d-mannose, vaginal oestrogen Consider face-to-face review if refractory UTI with complications [ 20 ] Acute retention: see face-to-face Defer all SPC and IDC changes [ 14 ] Acute retention: see face-to-face for IDC or SPC [ 3 ] If acute retention need emergency/urgent review (within 12 hours) for IDC If arranging TWOC, can defer on a case-by-case basis. If high PVR, then teach CISC Change of SPC can be delayed up to 3 months Aim for SPC change in community not hospital setting [ 25 ] Encourage conservative measures to help void, e.g. double/triple voiding Empirical treatment of UTI, including recurrent UTI Chronic urinary retention, e.g.…”

“…autonomic dysreflexia [ 14 ] Defer all cystoscopy for benign conditions [ 3 ] Defer all outpatient treatments and investigations, i.e. cystoscopy (non-cancer indications), bladder instillations, PTNS [ 16 ] Intravesical Botox suspended unless neurological bladder with upper tract risk Cystoscopy: perform within 2 months if risk factors for cancer and refractory OAB [ 25 ] If planned intravesical Botox, can defer and restart antimuscarinics/B3 agonists [ 36 ] Intravesical Botox postponed. Consider continuing under local anaesthesia for neurogenic bladder with renal tract complications [ 29 ] Intravesical Botox: non-essential, i.e., not time sensitive unless, e.g.…”