Department of Urology, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
Department of Urology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Int Braz J Urol. 2020 Jul;46(suppl.1):156-164. doi: 10.1590/S1677-5538.IBJU.2020.S119.
To explore the current situation faced by Latin American urology departments during the COVID-19 Outbreak in terms of knowledge, actions, prioritization of urology practices, and implementation of internal clinical management protocols for inpatients and outpatients.
A non-validated, structured, self-administered, electronic survey with 35 closed multiple choice questions was conducted in Spanish, Portuguese, Italian, and English and Deutsch versions from April 1st to April 30th, 2020. The survey was distributed through social networks and the official American Confederation of Urology (CAU) website. It was anonymous, mainly addressed to Latin American urologists and urology residents. It included 35 questions exploring different aspects: 1) Personal Protective Equipment (PPE) and internal management protocols for healthcare providers; 2) Priority surgeries and urological urgencies and 3) Inpatient and outpatient care.
Of 864 surveys received, 846 had at least 70% valid responses and were included in the statistical analyses. Surveys corresponded to South America in 62% of the cases, Central America and North America in 29.7%. 12.7% were residents. Regarding to PPE and internal management protocols, 88% confirmed the implementation of specific protocols and 45.4% have not received training to perform a safe clinical practice; only 2.3% reported being infected with COVID-19. 60.9% attended urgent surgeries. The following major uro-oncologic surgeries were reported as high priority: Radical Nephrectomy (RN) 58.4%, and Radical Cystectomy (RC) 57.3%. When we associate the capacity of hospitalization (urologic beds available) and percentage of high-priority surgery performed, we observed that centers with fewer urological beds (10-20) compared to centers with more urological beds (31-40) performed more frequently major urologic cancer surgeries: RN 54.5% vs 60.8% (p=0.0003), RC 53.1% vs 64.9% (p=0.005) respectively.
At the time of writing (May 13th 2020) our data represents a snapshot of COVID-19 outbreak in Latin American urological practices. Our findings have practical implications and should be contextualized considering many factors related to patients and urological care: The variability of health care scenarios, institutional capacity, heterogeneity and burden of urologic disease, impact of surgical indications and decision making when prioritizing and scheduling surgeries in times of COVID-19 pandemic.
探讨拉丁美洲泌尿外科部门在 COVID-19 爆发期间在知识、行动、泌尿外科实践优先级以及住院和门诊内部临床管理方案的实施方面面临的现状。
2020 年 4 月 1 日至 4 月 30 日，以西班牙语、葡萄牙语、意大利语、英语和德语版本进行了一项非有效、结构化、自我管理的电子调查，共 35 个封闭的多项选择题。该调查通过社交网络和美国泌尿外科联合会（CAU）官方网站分发。它是匿名的，主要针对拉丁美洲泌尿科医生和泌尿科住院医师。它包括 35 个问题，涉及不同方面：1）医护人员的个人防护设备（PPE）和内部管理方案；2）优先手术和泌尿科急症；3）住院和门诊护理。
在收到的 864 份调查中，846 份至少有 70%的有效回复，被纳入统计分析。调查中，南美洲占 62%，中美洲和北美洲占 29.7%。12.7%是住院医师。关于 PPE 和内部管理方案，88%的人确认实施了具体方案，45.4%的人没有接受过安全临床实践的培训；只有 2.3%的人报告感染了 COVID-19。60.9%的人接受了紧急手术。报告的主要泌尿肿瘤手术为高优先级：根治性肾切除术（RN）58.4%，根治性膀胱切除术（RC）57.3%。当我们将住院能力（可用泌尿科床位）与高优先级手术的百分比联系起来时，我们观察到，与拥有 31-40 个泌尿科床位的中心相比，拥有 10-20 个泌尿科床位的中心更频繁地进行主要的泌尿科癌症手术：RN 54.5%比 60.8%（p=0.0003），RC 53.1%比 64.9%（p=0.005）。
在撰写本文时（2020 年 5 月 13 日），我们的数据代表了拉丁美洲泌尿外科实践中 COVID-19 爆发的一个快照。我们的发现具有实际意义，应根据与患者和泌尿外科护理相关的许多因素进行背景化：医疗保健场景的可变性、机构能力、泌尿科疾病的异质性和负担、手术指征的影响以及在 COVID-19 大流行期间对手术进行优先排序和安排的决策。
