Travassos Thiago C, De Oliveira Joao Marcos Ibrahim, Selegatto Ivan B, Reis Leonardo O
UroScience, University of Campinas and Pontifical Catholic University of Campinas Campinas, SP, Brazil.
Am J Clin Exp Urol. 2021 Feb 15;9(1):132-139. eCollection 2021.
The world is going through an unprecedented time in history, and Urologists are, like many other healthcare professionals, facing and combating on two fronts: against the pandemic itself and cancer. When looking at the fatality rates, bladder cancer overcomes Coronavirus disease 2019 (COVID-19) by far and can be as high as 52%, so Urologists must not postpone investigation. Cystoscopy remains the gold standard for the investigation of bladder cancer and computed tomography (CT) urography for obtaining images of the upper tract in cases of macroscopic hematuria. Whenever transurethral resection of bladder tumor (TURB) is necessary, extra care must be taken to assure muscle sample, avoiding another surgical intervention and hospitalization, but when necessary it should not be postponed due to the elevated progression rate of the disease. Follow-up cystoscopies can be postponed for 6 months for low risk, 3 months for intermediate, 6 weeks for high risk, and not beyond 24 hours in case of emergencies as life-threatening hematuria, anemia, and urinary retention. Regarding chemotherapy, more than ever the key point is to evaluate each case individually. Bacille Calmette Guerin (BCG) must be considered only as an inducing course, in selected intermediate and most high-risk cancers. Whenever possible patients should be tested before surgery. Based on the current literature on optimal bladder cancer patients approach we comprehensively synthetize the major societies guidelines on the issue so far, adding a critical view to the topic. This article aims to guide Urologists on decision making against bladder cancer in the COVID-19 era.
世界正经历着前所未有的历史时期，泌尿外科医生与许多其他医疗保健专业人员一样，正面临并在两条战线上作战：对抗疫情本身和癌症。从死亡率来看，膀胱癌目前远远超过2019冠状病毒病（COVID-19），死亡率可能高达52%，因此泌尿外科医生绝不能推迟检查。膀胱镜检查仍然是膀胱癌检查的金标准，而计算机断层扫描（CT）尿路造影则用于在出现肉眼血尿时获取上尿路图像。每当需要进行经尿道膀胱肿瘤切除术（TURB）时，必须格外小心以确保获取肌肉样本，避免再次进行手术干预和住院，但如有必要，不应因疾病进展率升高而推迟手术。对于低风险患者，后续膀胱镜检查可推迟6个月；中风险患者可推迟3个月；高风险患者可推迟6周；对于危及生命的血尿、贫血和尿潴留等紧急情况，则不应超过24小时。关于化疗，比以往任何时候都更关键的是要对每个病例进行单独评估。卡介苗（BCG）仅应作为选定的中高危癌症的诱导疗程。只要有可能，应在手术前对患者进行检测。基于目前关于膀胱癌最佳治疗方法的文献，我们全面综合了迄今为止主要学会关于该问题的指南，并对该主题提出了批判性观点。本文旨在指导泌尿外科医生在COVID-19时代针对膀胱癌做出决策。
