Impact of COVID-19 on Outpatient Care for Urological Conditions at a University Hospital.

INTRODUCTION: The 2019 coronavirus (COVID-19) rapidly spread throughout the world, with diverse negative consequences in all fields, including the continuity of treatment for patients with other diseases. The public hospital for high-complexity procedures affiliated with the São José do Rio Preto School of Medicine, São Paulo, Brazil, normally has a high annual quantity of outpatient appointments. However, the consequences of COVID-19 led to a reduction in the number of appointments, exams, and outpatient procedures. The aim of the present study was to evaluate the impact of the pandemic on outpatient care for individuals with urological conditions at a university hospital. PATIENTS AND METHODS: A retrospective, descriptive, cross-sectional study was conducted involving the analysis of all outpatient appointments for individuals with urological conditions at the Urology Clinic of the São José do Rio Preto Hospital, São Paulo, Brazil, between January 2019 (pre-pandemic period) and December 2020 (after the first year of COVID-19). The variables of interest were sex, age, and affected organs of the genitourinary system. RESULTS: Among the 4,972 outpatient appointments involving patients with urological conditions in 2019, 70.7% involved males and the largest portion of patients were in the seventh decade of life (40.02%). Among the 4,584 outpatient appointments in 2020, 69.9% involved males and the largest portion were in the seventh decade of life (47.07%). Significant differences were found in the number of outpatient appointments between 2019 and 2020 in all age groups (p < 0.0001). The most affected organs of the genitourinary system in both 2019 and 2020 were the prostate (46.07% and 56.31%, respectively), bladder (30.56% and 22.48%, respectively), and kidney/ureter (22.85% and 19.68%, respectively), with no significant differences between the two years. CONCLUSION: The COVID-19 pandemic exerted an impact on outpatient care for individuals with urological conditions at a university hospital, leading to a reduction in the number of appointments. No change was found with regard to the sex of the patient. In contrast, an increase was found in the number of patients 60 years of age or older during the year of the pandemic. The most affected organs of the genitourinary system were the prostate, bladder, and kidney/ureter in both years analyzed.

Impact of the COVID-19 Pandemic on Surgical Treatment of Patients With Urological Diseases at a University Hospital.

BACKGROUND: The coronavirus disease 2019 (COVID-19) appeared in China and spread quickly to other regions of the country and around the world, changing the way of life of individuals and the routine of healthcare systems. OBJECTIVE: The aim of the present study was to investigate the impact of the pandemic on the surgical treatment of patients with urological diseases at a university hospital. MATERIALS AND METHODS: A retrospective analysis of the charts of patients with urological diseases submitted to surgical treatment between January 2019 and December 2020 was conducted. The variables of interest were age, sex, and most performed surgical procedures (double-J stent placement, cystoscopy, vasectomy, removal of double-J stent, ureterolithotripsy, endoscopic bladder procedure, kidney transplant, and endoscopic prostate procedure). RESULTS: Around 59.03% of patients with urological diseases who had surgery in 2019 were male; placement of the double-J stent accounted for 35.85% of all surgeries; 3556 surgical procedures were performed. In 2020, 57.22% of the patients were male, placement of the double-J stent accounted for 38.34% of all surgeries, and 3093 surgical procedures took place. Analyzing the types of surgery conducted in 2019 and 2020, a significant reduction occurred in the number of procedures in 2020 (p = 0.000). CONCLUSION: The pandemic exerted an impact on the surgical treatment of patients with urological diseases at a university hospital. No significant changes occurred with regard to the sex and age of the patients, but a significant difference was found in the number of surgical procedures performed.

Effect of systemic arterial pressure on erectile dysfunction in the initial stages of chronic arterial insufficiency.

OBJECTIVE: To report the effect of systemic arterial pressure on erectile dysfunction (ED) in patients in the initial stages of peripheral arterial disease. PATIENTS AND METHODS: All patients with a diagnosis of ED in the urology outpatient clinic of the Medicine School in São José do Rio Preto, Brazil were evaluated in a cross-sectional, quantitative study. The patients were assessed using the International Index of Erectile Function, the ankle-brachial index, and measurement of arterial blood pressure. Binary logistic regression, log-likelihood, Pearson chi-square and likelihood ratio chi-square and Kruskal-Wallis Test were used for statistical analysis with P < 0.05 being considered acceptable. Fifty-two patients (mean age 56.63 years) were enrolled in the study. RESULTS: Differences were detected between the median grades of ED of patients with differing degrees of chronic arterial insufficiency. Hypertensive patients in the initial stages of peripheral arterial disease had less severe grades of ED than normotensive patients. CONCLUSIONS: The progression of ED parallels the development of chronic arterial insufficiency. Systemic arterial hypertension in the initial stages of peripheral arterial disease might protect against ED, but peripheral arterial disease constitutes an aggravating factor for ED, and thus hypertension might exert a paradoxical effect in this stage of the disease.

Treatment of male genital lymphedema with non-elastic fabric.

Lymphedema is a specific type of edema stemming from a failure in the formation or drainage of lymph. This condition can be congenital or acquired. The clinical treatment of genital lymphedema involves compression mechanisms of the penis. In acquired cases, the individual is born with the lymphatic system intact, but this system is damaged at some point in life, which can lead to lymphatic insufficiency and the development of edema. The non-elastic material for the penis is grosgrain that enable the adjustment to the proper pressure. This report describes a case series of penile lymphedema treated with compression mechanism. Thirteen consecutive patients with penoscrotal lymphedema aged 22 to 56 years (mean: 42.3 years) were treated. Inclusion criteria were patients with primary and secondary penoscrotal lymphedema. Volume larger than three times the normal size of the scrotum was excluded. Reductions in edema occurred in the penis in all patients. Such reductions varied in accordance with the adherence of the patients to the use and duration of compression. The patients used the compression device at times that best fit their schedules. An interesting aspect was the fact that the patients reported the possibility of leaving the penis the size they wished-neither very small nor very large-for sexual activity. All were able to control the size of the edema within the standards they considered acceptable.

Xanthogranulomatous orchitis: case report of a rare condition.

Xanthogranulomatous orchitis is a rare, non-neoplastic inflammatory condition. We present a case of a 55-year-old diabetic male with an increase in volume, pain and edema in right testicle with a one-year history. The examination involved the investigation of inflammatory markers and ultrasound. Exploration of the scrotum revealed important destruction of the tissue architecture. This case underscores the importance of including xanthogranulomatous orchitis in the differential diagnosis of a testicular lump.

Clinical Treatment of Penile Fibrosis After Penoscrotal Lymphedema.

Genital lymphedema in men can affect the penis and/or scrotum, causing deformity and causing sexual limitations, social isolation, poor quality of life and recurrent subcutaneous infections due to difficulties in hygiene. There are few studies in the literature emphasizing the treatment of penile fibrosis after penoscrotal lymphedema. The purpose of this report is to describe a case of penile fibrosis treated using a new compression method.

Incidental Diagnosis of Bladder Cancer in a 17-year-old Patient.

Bladder cancer is the fourth most common type of cancer among males and the ninth most common cause of cancer death. Bladder cancer can occur at any age. This paper reports the incidental diagnosis of bladder cancer in a 17-year-old female patient. Data on bladder cancer at this age are uncommon in the literature.

Giant polycystic kidney and acute abdomen in chronic renal failure.

The case of a rare complication is reported of a 53-year-old patient with giant polycystic kidney (4250 g) that evolved with acute small bowel occlusion. The patient was submitted to surgery which identified that the intestinal occlusion was due to external compression of the intestinal loops. Excision of the mass solved the case.