Paediatric urology practice during COVID-19 pandemic

Cini, Chiara; Bortot, Giulia; Sforza, Simone; Mantovani, Alberto; Landi, L.; Esposito, Ciro; Escolino, Maria; Masieri, Lorenzo

doi:10.1016/j.jpurol.2020.04.023

Cited by 21 publications

(21 citation statements)

References 5 publications

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“…Of note, this comprehensive search did not identify any original research that examined endourology, reconstructive urology, paediatric urology, or functional urology. Because reviews were produced as results from the search pertaining to these topics, the search likely had adequate sensitivity [6,57]. Rather, this finding may represent a deficiency in original research in these fields.…”

Section: Discussionmentioning

confidence: 99%

Scoping review: hotspots for COVID-19 urological research: what is being published and from where?

Perera

Lawrentschuk

et al. 2020

World J Urol

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Purpose Contemporary, original research should be utilised to inform guidelines in urology relating to the COVID-19 pandemic. This comprehensive review aimed to: identify all up-to-date original publications relating to urology and COVID-19, characterise where publications were from, and outline what topics were investigated. Methods This review utilised a search strategy that assessed five electronic databases, additional grey literature, and global trial registries. All current published, in-press, and pre-print manuscripts were included. Eligible studies were required to be original research articles of any study design, reporting on COVID-19 or urology, in any of study population, intervention, comparison, or outcomes. Included studies were reported in a narrative synthesis format. Data were summarised according to primary reported outcome topic. A world heatmap was generated to represent where included studies originated from. Results Of the 6617 search results, 48 studies met final inclusion criteria, including 8 pre-prints and 7 ongoing studies from online registries. These studies originated from ten countries according to first author affiliation. Most studies originated from China (n = 13), followed by Italy (n = 12) and USA (n = 11). Topics of the study included pathophysiological, administrative, and clinical fields: translational (n = 14), COVID-19-related outcomes (n = 5), urology training (n = 4), telemedicine (n = 7), equipment and safety (n = 2), urology in general (n = 4), uro-oncology (n = 3), urolithiasis (n = 1), and kidney transplantation (n = 8). Conclusion This review has outlined available original research relevant to COVID-19 and urology from the international community. This summary may serve as a guide for future research priorities in this area.

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Section: Discussionmentioning

confidence: 99%

Scoping review: hotspots for COVID-19 urological research: what is being published and from where?

Perera

Lawrentschuk

et al. 2020

World J Urol

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“…The majority of the urological malignancies are given high priority and the required intervention is strongly Table 3 Urology care triage and recommendation 5,11,16,22,23,29,31,32,[38][39][40][42][43][44][45]49,50 recommended. 16,23,29,31 Urological surgeries can be triaged on basis of the COVID-19 test, cancer stage, the outcomes of delaying, and the provision of alternative treatment modalities.…”

Section: Uro-oncologymentioning

confidence: 99%

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Thapa

Shrestha²,

Bista

et al. 2021

Surg J (N Y)

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Background Coronavirus disease 2019 (COVID-19) has evolved as a pandemic of unimaginable magnitude. The health care system is facing a tremendous challenge to provide ethical and quality care. The transformation of the patient-based care to population-based care during the COVID-19 pandemic has raised ethical dilemma among urologists. Our objective is to explore the consensus in modified standard urology care, that can be adopted and applied during COVID-19 and similar pandemic. Methods We adopted an exploratory study design using secondary data. The data were extracted from a web-based medical library using keywords “COVID-19,” “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),” and “urology.” We identify and extrapolate (screening, eligibility, and inclusion) the data using PRISMA protocol, and summarize pandemic standard urology care under four main themes: (1) general urology care, (2) choice of surgical modality, (3) triage, and (4) urology training. Result We identified 63 academic papers related to our research question. The majority are expert opinions and perspectives on urology care. The common consensus is triage-based urology care and surgeries. Life or organ threatening conditions need immediate attention. Universal protective measures (personal protective equipment, safe operative environment) and protocol-based patient care are necessary to prevent and control SARS-CoV-2 infection. Conservation of the resources and its rational distribution provide an ethical basis for population-based health care during a pandemic. Informed decision making serves best to patients, families, and society during the public health crisis. Conclusion COVID-19 pandemic tends to transform standard urology practice into crisis standard population-based care. The consensus in crisis is drawn from evolving pieces of medical evidence and public health ethics. The provision of urology care during a pandemic is based on the availability of resources; severity of the disease, consequences of deferment of service, and dynamics of the pandemic.

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“…Health systems have been forced to redistribute resources toward emergency services and intensive care units. In an effort to preserve resources and protect patients and providers, most elective procedures have been postponed and while others have been performed using regional anesthesia in an effort to shorten hospital stays [ 1 ]. In adult surgery, clear guidance on how to decide which procedures should be prioritized were published during the pandemic [ 2 – 4 ].…”

Section: Introduction and Objectivementioning

confidence: 99%

“…It is unknown how much longer it will take once pandemic surge is contained and a plateau or recovery phase begins. As a result, the impact on morbidity and prognosis on our pediatric urological population is unknown [ 1 , 6 ].…”

Section: Introduction and Objectivementioning

confidence: 99%

Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us

et al. 2021

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Introduction and objective SARS-COV-2 pandemic has affected the population worldwide requiring social distancing, quarantine and isolation as strategies to control virus propagation. Initial measures to reduce the burden to the health care system during the pandemic included deferring elective surgery. These damage control measures did not take into account the mid- and long-term implications. Management of congenital anomalies can be time sensitive with delays resulting in permanent disability, morbidity and increased costs to the healthcare system. This study reports the results of using a novel scoring system that enables triage of time sensitive congenital anomalies and pediatric surgical conditions and how implementation of Enhanced Recovery After Surgery (ERAS®) principles allowed optimization of resources and reduced the burden to the system while allowing for appropriate care of pediatric patients with urgent urologic surgical conditions. Methods We present a prospective case series of patients with congenital urological conditions scheduled and taken to surgery during COVID-19 pandemic. All pediatric urology cases that were pending and or scheduled for surgery at the moment the pandemic struck as well as all cases that presented to the emergency department with urological conditions were triaged and included for analysis using a modified Medically Necessary, Time-Sensitive Procedures: Scoring System (MeNTS). A modified MeNTS was implemented for pediatric patients, giving more priority to the impact of deferring surgical intervention on patient’s prognosis. An individualized evaluation using this scoring system was applied to each patient. Intra- and postoperative ERAS ® principles were applied to all cases operated during the pandemic between March 20th and April 24th to reduce the burden to the healthcare system. Results A total of 49 patients were triaged and included for analysis with a mean age of 6.47 years of age. Adjusted MeNTS showed that all clinically emergent cases had a score of 12 or less. Cases that could be postponed for 2 weeks but no longer had a score between 13 and 15. The ones that could wait 6 weeks or longer had scores higher than 16. Score results were not the same for similar procedures and individualized assessments resulted in scores based on an individual patient’s conditions. From the total cases, implementation of ERAS ® principles increased outpatient procedures from 68 to 90.4%. Conclusion Our results provide a novel triaging method to rank pediatric urological surgical management based on individualized patient’s clinical conditions. Cutoff values of 12 and 16 allowed appropriate triage preventing the postponement of urgent urologic cases during the COVID-19 pandemic. Implementation of ERAS ® principles allowed for these procedures to be done in the outpatient setting, preserving valuable h...

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Paediatric urology practice during COVID-19 pandemic

Cited by 21 publications

References 5 publications

Scoping review: hotspots for COVID-19 urological research: what is being published and from where?

Scoping review: hotspots for COVID-19 urological research: what is being published and from where?

Urology during COVID-19 Pandemic Crisis: A Systematic Review

Risk-based stratification triaging system in pediatric urology: what COVID-19 pandemic has taught us

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