Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Eur Urol Focus. 2020 Sep 15;6(5):1032-1048. doi: 10.1016/j.euf.2020.05.007. Epub 2020 May 31.
CONTEXT: The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. OBJECTIVE: To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. EVIDENCE ACQUISITION: Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming "adaptive" and the future "chronic" phase of the COVID-19 pandemic. EVIDENCE SYNTHESIS: Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. CONCLUSIONS: The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. PATIENT SUMMARY: Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists' workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.
背景:由 2019 年冠状病毒病(COVID-19)大流行引起的前所未有的医疗保健情况彻底改变了全球泌尿科的实践。
目的:审查国际和欧洲国家泌尿科协会/学会(UAS)在当前紧急情况下发布的关于肿瘤和非肿瘤程序的优先策略的建议。
证据获取:2020 年 4 月 8 日至 18 日,在每个 UAS 官方网站上搜索有关诊断和治疗泌尿科程序的优先策略的任何文件、出版物或立场文件,以及有关远程医疗和微创手术使用的任何建议。我们详细收集了所有泌尿科程序的信息,按疾病、优先级(更高与更低)和患者设置(门诊与住院)进行分层。然后,我们批判性地讨论了这些建议对 COVID-19 大流行即将到来的“适应”和未来的“慢性”阶段的泌尿科实践的影响。
证据综合:总体而言,我们分析了 13 个 UAS 的建议,其中 4 个是国际的(美国泌尿科协会、美洲泌尿科协会、欧洲泌尿外科学会和澳大利亚和新西兰泌尿科协会),9 个是国家的(来自比利时、法国、德国、意大利、波兰、葡萄牙、荷兰和英国)。在门诊环境中,最有可能影响泌尿科医生未来工作量负担的程序是前列腺活检和良性疾病的选择性手术。在住院环境中,对这种负担的最大贡献者是风险较低的前列腺癌和肾癌、非梗阻性结石病和良性前列腺增生的选择性手术。最后,一些 UAS 建议进行微创手术时要特别注意,而另一些 UAS 则概述了远程医疗在当前和未来情况下优化资源的潜在作用。
结论:预计的变化将给全球泌尿科带来重大压力,包括泌尿科医生的整体工作量、内部物流、手术患者的流入和候补名单。鉴于这些预测,泌尿科医生应努力利用这一紧急时期重塑他们未来的角色。
患者总结:总体而言,不同的泌尿科协会/学会之间在大多数泌尿科程序的优先级方面达成了很大共识,包括门诊环境、泌尿科急症以及许多针对肿瘤和非肿瘤疾病的住院手术。然而,在一些特定的癌症手术方面(即高危膀胱癌的根治性膀胱切除术和较大的器官局限肾肿瘤的肾切除术)发现了一些差异,这可能是由于不同的优先级标准和/或医疗保健背景所致。未来,最有可能影响泌尿科医生工作量负担的门诊程序是前列腺活检和良性疾病的选择性手术。在住院环境中,对这种负担的最大贡献者是风险较低的前列腺癌和肾癌、非梗阻性结石病和良性前列腺增生的选择性手术。
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