Prenatal diagnosis and telemedicine consultation of fetal urologic disorders

Abstract

In Arkansas, telemedicine is used commonly in obstetrics through Antenatal and Neonatal Guidelines, Education and Learning System (ANGELS), the existing statewide telemedicine network. This network is used primarily for tele-ultrasound and maternal-fetal medicine consultation. This study is a retrospective case series, describing all the patients who had a prenatally diagnosed urologic anomaly that required prenatal urologic consultation. From 2009-2013, approximately 1300 anomalies were recorded in the Arkansas Fetal Diagnosis and Management (AFDM) database, 14% of which were urologic anomalies. Twenty-six cases required prenatal urologic consultation, 25 of which were conducted via telemedicine. Teleconsultation allowed patients to combine maternal-fetal medicine and urologic consultations in one visit, saving time and effort and ultimately, for most patients, providing reassurance that delivery could be accomplished locally with postnatal follow-up already arranged. While there are several studies reporting the use of telemedicine for various subspecialty consultations, to our knowledge, this is the first to describe the use of telemedicine for prenatal urology consultation. Future research could randomize patients prospectively to allow comparison of both the outcomes as well as the patient experience.

Benefits and barriers to pediatric tele-urology during the COVID-19 pandemic

“…Prior to the COVID-19 pandemic, telemedicine was an under-utilized form of delivering health care in the field of pediatric urology [ 10 ]. Prior studies have demonstrated successful telemedicine encounters for post-operative visits as well as for prenatal consultations on urologic conditions, most commonly including urinary tract dilation [ [5] , [6] , [7] ]. Out of necessity, the pandemic has changed the way practitioners have traditionally provided services in order to maintain quality care for pediatric urologic patients.…”

“…Telemedicine allows for the delivery of care while maintaining safe social-distancing measures. Remote video visits (VVs) have been used successfully for years in pediatric urology for the delivery of postoperative care [5,6] and prenatal urologic consultation [7]. Yet overall, there is a paucity of existing research on the use of telemedicine for general pediatric urologic conditions.…”

Efficacy and satisfaction of preoperative telemedicine evaluation of pediatric urologic patients

“…Telemedicine has been used sparingly in the United States for the management of pediatric urologic patients post-surgery and for follow-up of medical conditions like enuresis. No evidence exists in the literature in this country examining its potential utility in the preoperative setting in urology (6)(7)(8)(9). In addition to reports of management of medical diseases and postoperative follow-up, prior studies in Canada and Australia have demonstrated utilization of telemedicine in preoperative care in a standard clinic-to-clinic telehealth model.…”

“…The distance required for in-person evaluation of pediatric urologic diseases can be economically and logistically challenging for patients and families. Consequently, our urology division implemented a telemedicine program almost 10 years ago and has reported the feasibility of telemedicine in multiple areas, such as postoperative evaluation, prenatal consultation, and follow-up management of enuresis (6)(7)(8).…”

Telemedicine preferences in pediatric urology following the COVID-19 pandemic: A caregiver survey

“…Prior to the pandemic, there had been marginal interest in expanding the usage of telemedicine in the United States, including in specialities such as pediatric urology. Telemedicine was not widely used by pediatric urologists prior to the COVID-19 pandemic with only a few examples demonstrating its utility for postoperative evaluations (2,3), prenatal consultations (4), and management of enuresis (5). As in many other specialties, pediatric urologists were forced to rapidly increase usage of this type of patient care due to restrictions linked to the pandemic (6)(7)(8).…”