[Functional urology during COVID-19: Recommendations during de-escalation.] / La urología funcional en la era COVID-19. Consejos para la desescalada.

OBJECTIVES: Due to the COVID-19 Pandemic, all surgical activity that was not life threatening was cancelled , as well as most face-to-face consultations. Currently the beginning of the de-escalation phases that will led us to a new normal, forces us to establish some degree of priority in the interventions as well as in the medical consultations. Our objective is to establish some recommendation on Functional Urology office visits and surgical interventions that serve as a tool to facilitate decision-making. MATERIAL AND METHODS: Experts in Functional Urology from different autonomous communities of Spain were contacted to design a strategy to reorganize the activity of both, diagnosis and treatment. A modified nominal group technique has been used due to the extraordinary restrictions of assembly and mobility during the COVID pandemic. The first signer (EMC) made the first draft with the measures adopted and the strategy to be followed during the evolution of the COVID-19 pandemic. The proposal was sent to the rest of the authors, in order to unify criteria and experiences to reach a quick consensus on the relative priority of the different activities, problems and solutions. A final version was approved by all authors May 27, 2020. RESULTS: Tables of recommendation have been prepared for outpatient consultation, surgical and technical interventions, according to de-escalation phases proposed by the Spanish Associations of Surgeons. CONCLUSIONS: The change that COVID-19 Pandemich as involved in our clinical practice force us to seek alternative methods to treat our patients, some of which may already be established. Mean while, a consensusin decision making is necessary. Documents such as the current one, are intended to guide the management of patients with urological functional pathology in exceptional situations. Logically, it should be adapted to material and human availability, and to the idiosyncrasy of each Urology service.

OBJETIVOS: Debido a la Pandemia COVID-19 se suspendió toda actividad quirúrgica que no fuera una urgencia vital, así como la mayoría de consultas presenciales. Actualmente el inicio de las fases dedesescalada que nos llevarán a una nueva normalidad nos obliga a establecer unos grados de prioridad en las intervenciones así como en las consultas médicas. Nuestro objetivo es establecer una serie de recomendaciones sobre las consultas de Urología Funcional y las intervenciones quirúrgicas que sirva como herramientade ayuda en la toma de decisiones.MATERIAL Y MÉTODOS: Expertos en Urología Funcionalde distintas comunidades autónomas de España fueron contactados para diseñar una estrategia parareorganizar la actividad tanto de diagnóstico como de tratamiento. Se ha utilizado una técnica de grupo nominal modificada debido a las restricciones extraordinarias de reunión y movilidad durante la pandemia COVID. El primer firmante (EMC) realizó el primer borrado rcon las medidas adoptadas y la estrategia a seguir durante la evolución de la pandemia COVID19. Se remitió la propuesta al resto de autores, con el fin de unificar criterios y experiencias para llegar a un rápido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones. Se realizó una versión definitiva, aprobada por todos los autores, el día 27 de mayo de 2020. RESULTADOS: Se han elaborado tablas de recomendaciones tanto para consultas externas, como para intervenciones quirúrgicas y técnicas, de acuerdo con las fases de desescalada propuestas por la Asociación Española de Cirujanos (AEC). CONCLUSIONES: El cambio que ha supuesto la Pandemia COVID-19 en nuestra práctica clínica nos obliga a buscar métodos alternativos para seguir y tratar a nuestros pacientes, algunos de los cuales pueden ya quedar instaurados. Mientras, es necesario un consenso en la toma de decisiones. Documentos como el actual, pretenden orientar en el manejo de los pacientes con patología funcional urológica en situaciones excepcionales. Lógicamente, deberá adaptarse alas disponibilidades materiales y humanas, y a la idiosincrasia de cada servicio de Urología.

Position of Ibero-American Society of Neurourology and UroGynecology (SINUG) on the use of vaginal meshes in pelvic organ prolapse.

AIMS: Pelvic organ prolapse (POP) is a very prevalent condition with a great impact on women's quality of life. At present, there is great controversy regarding the use of mesh in POP surgery. To understand the current moment, it is advisable to make a brief summary of the historical evolution of mesh use for pelvic floor pathology. The aim of this paper is to establish the position of the Ibero-American Society of Neurourology and UroGynecology (SINUG for its acronym in Spanish) regarding vaginal mesh reconstructive surgery. METHODS: A working committee from the SINUG's scientific board performed a literature search about the use of vaginal meshes for pelvic organ prolapse reconstructive surgery and about the position of different societies. We analyzed the evolution into three periods: before the Food and Drug Administration (FDA) statement, FDA statement, and after the statement. SINUG drew up a position statement regarding vaginal mesh reconstructive surgery, based on the available scientific evidence and the evolution of its use in different contexts. RESULTS: Before mesh appearance in the 1990s, native tissue repair was the surgical treatment of choice for POP. Vaginal mesh reconstructive surgery has been frequently accompanied by procedure underestimation by inexperienced surgeons, besides inadequate diagnoses and indications. This situation led to the presentation of serious complications including mesh extrusion, exposure, and contraction. CONCLUSIONS: Once reviewed the available evidence and the position of different societies, SINUG presents its vision in this communication, which is a summary of the document prepared by the society's scientific board.