Considerations in the Triage of Urologic Surgeries During the COVID-19 Pandemic

A War on Two Fronts: Cancer Care in the Time of COVID-19

“…Decision making may change as efforts by the health care system to mitigate risks for exposure to COVID-19 improve (5). Indeed, consensus recommendations swiftly began to appear to help providers make appropriate triage decisions (6). For persons with advanced oncologic disease, futility of treatment in the context of COVID-19 must be frankly considered and discussed.…”

COVID‐19 and urology: a comprehensive review of the literature

“…Cancer care is an integral part of daily urological practice with prostate cancer, urinary bladder cancer, and renal cancer, accounting for 7.1%, 3.0%, and 2.2% of all cancers, respectively [56]. However, the delay of onco‐urological surgeries may have an impact on short‐term progression and/or mortality rates [57], as a result of the limited availability of ventilators and anaesthesiologists, and the suspension of all elective surgeries Ficarra et al [30] divided urological cancer surgeries into four categories; (i) non‐deferrable cancer surgeries include all procedures in which a delay may negatively affect oncological or functional outcomes, e.g., patients with bladder cancer (consider transurethral resection of bladder tumour [TURBT] for high risk non‐muscle‐invasive bladder cancer, any high‐grade bladder cancer, or tumours >2 cm at the time of diagnosis, while radical cystectomy and urinary diversion should be considered for muscle‐invasive bladder cancer or refractory carcinoma in situ ), testicular cancer (radical orchidectomy), clinical T2–4 renal cancers (radical nephrectomy), high‐grade upper tract urothelial carcinoma (radical nephroureterectomy), high‐risk or locally advanced prostatic carcinoma (radical prostatectomy [RP] with pelvic lymph node dissection), or clinical >T1G3 penile cancer (partial penectomy); (ii) semi‐non‐deferrable cancer surgeries should be consider in regions with limited diffusion of COVID‐19 and include oncological surgeries for patients with intermediate‐ and high‐risk prostatic carcinoma (RP), low‐grade and small bladder tumours (consider TURBT), and renal tumours cT1b (consider partial or radical nephrectomy); (iii) deferrable cancer surgeries; and (iv) replaceable cancer surgeries (all other urological malignancies can be weighed as deferrable or replaced by other treatment options) [30]. Similarly, Stensland et al [57] reported similar recommendations for urological oncology with two main differences from the recommendations reported by Ficarra et al [30]; (i) they recommended that most RPs should be delayed (selected high‐risk, all intermediate‐risk, and all‐risk prostate cancer) or offered radiation therapy based on the National Comprehensive Cancer Network (NCCN) guidelines; and (ii) they recommended adrenalectomy for adrenal tumours >6 cm.…”

Impact of the COVID-19 Pandemic on the Urologist’s clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period

“…In addition to the procedures previously mentioned, non-urologic oncology conditions that deserve urgent treatment are testicular torsion, scrotal abscess and / or Fournier's Syndrome, infection of penile prosthesis or artificial sphincter, priapism and urological trauma. We should consider postponing surgical treatment for all other urological conditions, such as urinary incontinence, prolapses, urethral stenosis, prosthetic implants, infertility-related operations (including vasectomy) and genital procedures such as circumcision or hydrocele correction (15).…”