The multifaceted long-term effects of the COVID-19 pandemic on urology

Morlacco, Alessandro; Motterle, Giovanni; Zattoni, Filiberto

doi:10.1038/s41585-020-0331-y

Cited by 24 publications

(26 citation statements)

References 9 publications

(5 reference statements)

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“…Urologists in private practice (61.2% of the participants) were more profoundly affected and had a 3.7 times higher chance of experimenting a >75% income reduction in comparison with those working as employees in the private or public sector. Such major reduction in practice and income has been reported in other countries and with other medical specialties (5,12,(25)(26)(27)(28)(29). Consistent with the observed income cutback, a great proportion of Brazilian urologists have already implemented cost containment measures in their professional and personal lives.…”

Section: Discussionsupporting

confidence: 65%

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

et al. 2020

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Objectives: To evaluate the impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists during the month of April 2020. Materials and Methods: A 39-question, web-based survey was sent to all urologist members of the Brazilian Society of Urology. We assessed socio-demographic, professional, health and behavior parameters. The primary goal was to evaluate changes in urologists' clinical practice and income after two months of COVID-19. We also looked at geographical differences based on the incidence rates of COVID-19 in different states. Results: Among 766 urologists who completed the survey, a reduction ≥ 50% of patient visits, elective and emergency surgeries was reported by 83.2%, 89.6% and 54.8%, respectively. An income reduction of ≥ 50% was reported by 54.3%. Measures to reduce costs were implemented by most. Video consultations were performed by 38.7%. Modifications in health and lifestyle included weight gain (32.9%), reduced physical activity (60.0%), increased alcoholic intake (39.9%) and reduced sexual activity (34.9%). Finally, 13.5% of Brazilian urologists were infected with SARS-CoV-2 and about one third required hospitalization. Urologists from the highest COVID-19 incidence states were at a higher risk to have a reduction of patient visits and nonessential surgeries (OR=2.95, 95% CI 1.86-4.75; p< 0.0001) and of being infected with SARS-CoV-2 (OR=4.36 95%CI 1.74-10.54, p=0.012). Conclusions: COVID-19 produced massive disturbances in Brazilian urologists' practice, with major reductions in patient visits and surgical procedures. Distressing consequences were also observed on physicians' income, health and personal lives. These findings are probably applicable to other medical specialties.

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Section: Discussionsupporting

confidence: 65%

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

et al. 2020

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“…There has undoubtedly been an opportunity cost, with significant effects on training and operative experience. This is neither unique to our unit nor indeed to our country [ 10 , 11 ]. Much time was spent re-triaging the clinical and operative waiting list, based on limited clinical information.…”

Section: Discussionmentioning

confidence: 99%

Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre

et al. 2020

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Purpose Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. Methods Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. Results Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. Conclusion Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

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“…26 The office-based diagnostic procedures (flexible cystoscopy, pressure flow studies) for the benign condition can be deferred. The outpatient urological procedures like prostate Table 2 Principles and ethical values behind urology care triage during pandemic 4,11,[14][15][16]23,29,45,52 • Status of SARS-CoV-2 test and COVID-19 disease condition.…”

Section: Outpatient Urology Carementioning

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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The multifaceted long-term effects of the COVID-19 pandemic on urology

Cited by 24 publications

References 9 publications

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

Impact of COVID-19 on clinical practice, income, health and lifestyle behavior of Brazilian urologists

Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre

Urology during COVID-19 Pandemic Crisis: A Systematic Review

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