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

Abstract

Introduction and hypothesis The coronavirus (COVID-19) pandemic has impacted health systems worldwide. There is a continuing need for clinicians to adapt practice to facilitate timely provision of medical care, whilst minimising horizontal transmission. Guidance and recommendations are increasingly available, and this rapid review aimed to provide a timely evidence synthesis on the current recommendations surrounding urogynaecological care. Methods We performed a literature review using PubMed/Medline, Embase and Cochrane and a manual search of national and international societies for management recommendations for urogynaecological patients during the COVID-19 pandemic. Results Nine guidance documents and 17 articles, including 10 reviews, were included. Virtual clinics are recommended for new and follow-up patients, to assess and initiate treatment, as well as triage patients who require face-to-face appointments. Outpatient investigations such as urodynamics and cystoscopy for benign indications can be deferred. Prolapse and continence surgery should be suspended, except in specific circumstances such as procidentia with upper tract complications and failed pessaries. There is no evidence to support a particular route of surgery, but recommendations are made to minimise COVID-19 transmission. Conclusions Urogynaecological patients face particular challenges owing to inherent vulnerabilities of these populations. Behavioural and medical therapies should be recommended as first line options and initiated via virtual or remote clinics, which are integral to management during the COVID-19 pandemic. Expanding the availability and accessibility of technology will be increasingly required. The majority of outpatient and inpatient procedures can be deferred, but the longer-term effects of such practices are unclear.

Impact of COVID-19 in gynaecological oncology care: a systematic rapid review

“…The rapid review’s research questions and methods, including search strategy and inclusion criteria, were pre-defined in a research protocol document. This study was undertaken by a working group led by CHORUS: An International Collaboration for Harmonising Outcomes, Research, and Standards in Urogynaecology and Women's Health ( https://i-chorus.org/ ), applying similar methodology standards to a recently published rapid review in urogynaecological practice [ 9 ]. Our methodology has been adapted from recent methodological guidance published by Cochrane [ 7 ].…”

A meta‐synthesis of qualitative studies on stress urinary incontinence in women for the development of a Core Outcome Set: A systematic review

“…Our research group included members with a special interest in pelvic floor disorders and research, within the scope of CHORUS, An International Collaboration for Harmonising Outcomes, Research and Standards in Urogynaecology and Women's Health (https://ichorus.org/). [14][15][16][17][18][19][20][21][22] This study is part of the process of development of COS for SUI.…”

Safe urodynamic practices in times of COVID‐19: What can be accomplished and what can be added?

“…Because UDS are generally indicated to diagnose nonurgent conditions, many patients postponed their UDS, and many physicians, in turn, reduced the frequency of performing or simply stopped performing these exams in recent months. 1 , 2 However, as UDS are considered the gold standard for the diagnosis of various lower urinary tract disorders, 3 we do not yet know the long‐term health consequences of this reduced access to care.…”

“…The COVID‐19 pandemic has disrupted urological practice substantially. Reductions in the number of surgeries, medical consultations, and elective procedures are examples of impediments due to the social distancing necessary to control SARS‐CoV‐2 transmission 1,2 . In this context, the performance of urodynamic studies (UDS) has also been encumbered.…”