COVID-19- A Challenge for Urology Subspecialty in an overwhelmed public sector hospital: A Descriptive Review of Urology Department, Lady Reading Hospital

Background: COVID-19 has brought unprecedented changes in every aspect of life throughout the world including the healthcare delivery system. After a grinding halt in surgical practice due to this pandemic, the conventional protocols needed a thorough overhaul before kick-starting formal services. This study discusses ways and procedure changes adopted at the Urology department to navigate this crisis and extend adequate urological care to patients at the same time. Aim(s): To share our experience of patient management in the era of the COVID-19 pandemic. Method(s): It's a descriptive review article based on patient management protocols and clinical audit in the era of COVID-19 pandemic at the Departmentof Urology, MTI, Lady Reading Hospital from 20th Marchto 20th June 2020. Clinical implication the benefit of this study is how to organize things and continue health care provision in a deadly pandemic. Furthermore, it will set a precedence that how to cope with such a pandemic in the future. Conclusion(s): All surgical patients should be screened for COVID-19, with preference given to PCR tests. All elective surgeries should be put on hold as a result of the limited availability of ventilators, manpower, and hospital beds. Only semi-elective, lifesaving and oncologic surgeries that cannot be delayed should be done with full PPEs provided to every personnel frequenting operating theaters during the procedure. Furthermore, more efforts are needed to lift the infrastructure of hospitals and make them capable to face problems of such proportions in the future.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Telemedicine for Pediatric Urological Care during the Covid-19 Pandemic

Purpose of Study: We hypothesize that patient and parent satisfaction of telemedicine is influenced by patient key indicators. By delineating these key indicators, we can strategically utilize video visits in a way that maximizes patient satisfaction, while maintaining high quality care. The aim of this study is to reveal which key indicators are predictive of patient and parent satisfaction with video visits. Methods Used: We performed a retrospective review of all patients and parents who were evaluated via video visit for Loma Linda University Pediatric Urology from October 2021 - April 2022. All patients received an 8-question validated satisfaction survey via email within 30 days of the visit. Patient demographics, clinical data, and survey responses were collected. We analyzed all patients who completed a telemedicine visit and the post-visit survey. Exclusion criteria included incomplete survey responses. Primary outcomes include high satisfaction scores on survey questions. Univariate analysis was conducted for indicators of patient and parent satisfaction using Pearson correlation, Mann-Whitney U, and Chi Squared, with clinical significance defined as p value < 0.05 using SPSS. Summary of Results: A total of 1213 patients had video visits from October 2021 - April 2022. Of those who completed a video visit, 83 patients (7%) completed the satisfaction survey. Of those who completed the survey, 40 (48%) were post-operative visits, 29 (35%) were follow-up visits, and 14 (17%) were new visits. Families said telemedicine saved them time (84%), saved them money (31%), allowed them to avoid time away from work (30%), allowed their child to avoid missing school (27%), and that they did not experience any technical issues (86%). Mean overall satisfaction score (1-5) was 4.36 for post-op circumcision patients and 4.80 for post-op orchiopexy patients. Median travel distance saved by performing a video visit was 22 miles (IQR 15 - 41 miles). Compared to those who lived closer, patients who lived farther than 22 miles from the clinic had significantly higher satisfaction scores for Q3 (p < 0.019) and Q4 (p < 0.049) [reference Table]. Compared to higher household incomes based on zip code, patients with lower than median household income of $64,384 had significantly higher satisfaction scores for Q1 (p < 0.032), Q3 (p < 0.039), and Q4 (p < 0.040). Patients with public insurance had significantly higher satisfaction scores compared to those with private insurance for Q1 (4.68 vs 4.15, p < 0.022), Q2 (4.90 vs 4.64, p < 0.018), and Q3 (4.82 vs 4.58, p < 0.050). Median parent age was 40 (IQR 32.4 - 42.2 years). There was no difference in satisfaction based on visit type or parent age. Conclusion(s): Overall, patients and parents in pediatric urology are satisfied with video visits across visit type and diagnosis. Patients who live farther away from the office, live in zip codes with lower median household incomes, or have public insurance seem to be more satisfied with video visits. (Table Presented).

Did the COVID-19 Pandemic Restrict Access to Emergency Urological Services: Assessment of Reorganisation Effectiveness for Hospital Treatment.

Urolithiasis derived renal colic is a common urological condition. If treated properly, the disease resolves without complications; if not treated, it causes infection and renal failure. The COVID-19 restrictions impacted hospitalised treatment of diseases. We analysed the impact of COVID-19 on renal colic treatment at a hospital in Poland. Clinical and demographic data of patients treated during the COVID-19 era were compared with those treated before this pandemic. During the COVID-19 restrictions, renal colic patient hospital admissions fell significantly. However, more patients presented with chronic renal colic symptoms and urinary tract infections. Nevertheless, the degree of hydronephrosis and the number and location of stones did not differ between the two groups. No marked changes were observed in the chosen treatment options. The observed decrease in emergency admissions of patients with acute renal colic with a simultaneous increase in the rate of infectious stones might indicate that some patients requiring urgent medical help did not report to the emergency department or came later than they would before the pandemic, reporting more serious symptoms. One plausible explanation for this may be that the reorganisation of the healthcare system restricted access to urological care. Moreover, some patients may have delayed their visit to the hospital due to the fear of contracting the SARS-CoV-2 coronavirus.

IMPACT AND IMPLICATIONS OF THE COVID-19 PANDEMIC ON UROLOGIC TRAINING

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted many facets of healthcare in the United States. Changes in public health and hospital policies led to changes in the surgical care of patients and caused disruptions in medical training. Currently, there is limited understanding of how significantly the pandemic impacted urology resident education across the U.S. The aim of this project is to examine the trends in urologic procedures, as captured by the Accreditation Council for Graduate Medical Education (ACGME) performed by residents before, during and after the peak of the COVID-19 pandemic. METHODS: A retrospective review was performed of publicly available urology resident case logs between July 1 2016 and June 30 2021. Cases were divided into subcategories defined by ACGME and analyzed with linear regression models using year and category as predictors. Statistical calculations were conducted using R (version 4.0.2). RESULTS: Statistical analysis of the national average number of procedures performed by urology residents indicate an upward trend of urology cases. Starting in 2016, the national average of general urology procedures performed by residents has increased by 4-5 each year except for 2020, which saw a drop in case volume. However, in 2021 the case volume dramatically increased to the same rate as projected had there not been a disruption in 2020. The same analysis applied to other categories of urology procedures resulted in the same findings of a decrease in 2020 followed by a quick rebound in 2021. CONCLUSIONS: Trends in ACGME urologic resident case logs suggest that despite widespread pandemic-related disruptions in surgical case volume, there has been minimal detriment to urologic resident training over time. Urologic care is essential and in high demand as evidenced by the uptick in volume across training programs within the U.S.

THE CONTINUING IMPACT OF THE COVID-19 PANDEMIC ON PROSTATE CANCER MANAGEMENT: A POPULATION BASED ANALYSIS

INTRODUCTION AND OBJECTIVE: Since early 2020, the global pandemic caused by COVID-19 has resulted in considerable healthcare related and economic impacts. To mitigate health impact to the wider population, restrictions on non-essential services were imposed. Australia performed favourably compared to other developed countries, largely due to these state-initiated transient 'lock-downs' to control local outbreaks. Recommendations to limit non-urgent urologic care were formulated to optimise patient safety and many of these were adopted in Australia. We aimed to extend this analysis to observe the trend in PSA tests, biopsies, and radical prostatectomies in the first 18 months of the pandemic, from January 2020 through to mid-2021, and compare these to the previous ten years. METHODS: Medicare Benefits Schedule data was extracted per state and per month from January 2010 to June 2021 for PSA tests, prostate biopsies, and radical prostatectomies. Each item was plotted as a two-year trend, with the count of tests/procedures expressed as a ratio to the first January count of that two-year period. Data on the number of covid cases per day to 30th June 2021, as a 7-day average. RESULTS: A sharp fall in PSA tests among all states was seen in April 2020 as the first wave of COVID-19 cases were detected and lockdown measures initiated. Test numbers rebounded quickly but remained slightly below the long-term trend (Figure 1, green line). For biopsy procedures, a decline from the expected trend began in March/ April 2020 but generally remained below trend for the remainder of the year for most states within Australia. The observed deviation for radical prostatectomies commenced later than biopsies, with an apparent two- or three-month lag. In comparison to the longer-term average trend, from Jan 2020 to Jun 2021 it is estimated that there were 15% fewer PSA tests, 16% fewer biopsies and 17% fewer prostatectomies in Australia. CONCLUSIONS: The consequence of periodic lockdowns in response to COVID19 on patterns of care on stage at presentation and oncological outcomes is unknown but should be measured. As vaccination rates rise globally, it is expected that strict COVID-19 mitigation measures will not be required, therefore limiting the consequent impact on prostate cancer management contained.

PATTERNS OF TELE-HEALTH USAGE AFTER THE COVID-19 PANDEMIC AMONG SURGICAL SPECIALTIES AND UROLOGY

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has accelerated the adoption of telemedicine, defined as the real-time, interactive delivery of healthcare information electronically, particularly within urology. However, literature has found that elderly and Black patients are less likely to complete or prefer a tele-health visit. This study aims to understand the impact of various socio-demographic factors on patterns in tele-health usage after the first wave of the COVID-19 pandemic among all surgical specialties and within urology specifically. METHODS: Data on race, ethnicity, type of visit, visit method, language preference, and insurance type was extracted directly from visit information for all surgical specialty visits at the Brigham and Women's Hospital from five three-month time periods in 2019 and 2020. Variables were re-coded to fit a binary outcome for each. Chi-square tests were performed for univariable analysis. A difference-indifferences regression model controlling for time-invariable cofactors was used to examine the effect of each variable on the change in proportion of virtual visits between all possible pairs of time periods. Our exposure variables of interest were Black race, status as Medicare beneficiary, and preference for non-English language with control variables of White race, non-Medicare beneficiary, and primarily English-speaking status, respectively. All analysis was performed in R. RESULTS: Our dataset included a total of 182,074 surgical specialty visits. Although total visits decreased during the pandemic period, total visits before and after the first-wave period were comparable. When compared to White patients, the proportion of virtual visits for Black patients after the first wave was 8.3% higher than expected among all surgical specialties, but 7.3% lower than expected within only urology visits (p<0.01). When compared to non- Medicare beneficiaries, the proportion of virtual visits for Medicare beneficiaries after the first wave was about 6% lower than expected across all surgical specialties and urology only (p<0.01). When compared to English-speaking patients, the proportion of virtual visits for non-English speaking patients after the first wave was 4% less than expected among all specialties and 12% less than expected among urology only (p<0.01). CONCLUSIONS: Usage of tele-health by Black patients, Medicare beneficiaries, and non-English speaking patients is lower than expected in urology. Understanding disparities in tele-health usage may help inform policy that could alleviate inequities in access to urologic care.

Impact of the COVID-19 pandemic on urologic care delivery in the United States

Introduction & Objectives: The impact of the COVID-19 pandemic on health care access and delivery in the US has been reported for hospital admissions and in the outpatient setting for a few selected health conditions. However, the impact on specialty care has not been adequately characterized. We therefore aimed to determine trends in outpatient urologic care visit and procedural volume in 2020, using a specialty-wide, community-based registry. Materials & Methods: The American Urological Association Quality (AQUA) Registry collects data via automated extraction from electronic health record systems at 157 urology practices representing 3,165 providers (roughly one-quarter of US urologists) across 48 US states and territories. We analyzed trends in care delivery from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features. The primary outcomes were mean visit volume and procedure volume per practice per week, and we compared each week to the corresponding week in 2019. Results: There were 2,750,001 patients in our cohort, accounting for 8,953,832 outpatient visits and 1,570,161 procedures. We found large (>40%) declines in outpatient visits from March to April 2020 across all demographic groups and US states, regardless of timing of stay-at-home orders. Visits recovered through May and early June, but began falling again by early July (see Figure). Non-urgent visits and procedures decreased more (39–47%) than visits for urgent diagnoses (29–43%);surgical procedures for non-urgent conditions also decreased more (37–53%) than those for potentially urgent conditions (13–21%). African American and Hispanic patients had smaller decreases in visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients (mostly over 65 years old) had the steepest declines (50%) while those on Medicaid (generally low-income) had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. (Figure Presented) Conclusions: This study provides timely, real-world evidence on the magnitude of decline in the provision of urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses.

Effects of the first-wave COVID-19 pandemic's on emergency urological care in Colombia: A multicenter study

Introduction: The COVID-19 pandemics has caused millions of deaths worldwide, has increased the demand for in-hospital beds and has affected in-hospital activities of "non-respiratory patients." There is currently no known effect of the pandemic on the emergency urological care in our region. This study aims to estimate the first - wave COVID-19 pandemics effect on emergency urological care in four tertiary Colombian hospitals. Material and methods: A cross-sectional retrospective multicenter study were made. The emergency urological care activities between April - May 2019 and April - May 2020 were compared. We calculated descriptive statistics and assessed differences during the study periods. We used Stata 13.0. Results: 1570 patients were included. There was a 22.20% decrease in the number of patients who visited the emergency room (ER) for urological disease during the pandemic's initial phase. Urolithiasis and urological infectious were the most common reasons for consulting in the ER. The surgical index for patients who required emergency urological care had a increase of 10.74% (p: 0.0001). There was a decrease of 0.74 days in hospital stay for patients who required urological emergency care in the initial COVID-19 pandemic period. Conclusions: The COVID-19 pandemic has had a significant impact on emergency and elective urological care worldwide. During the initial phase of this emergency, there was a significant decreased in hospital admission and average hospital stays due to urological emergencies in Colombia, however, the surgical index for critical urological diseases increased by 10.74%. According to the pandemićs dynamics, a greater effect on urological care is expected..

Transforming the Urology clinic to a procedure-oriented center improves the quality of urological care and patient experience

Introduction & Objective: The global pandemic of COVID 19 necessitated limitations for in-person visits to stop the spread of the virus. At our institution, we sought to maintain patient access while delivering safe socially distanced care. We hypothesized that transitioning the clinics into a procedure-oriented center would create a safer, more efficient model for patient care delivery. Methods: Transitioning the clinic consisted of adopting Telehealth visits for the majority of patient's consultations while augmenting the use of physical space in the clinic to facilitate urological procedures. Multiple productivity, financial and patients experience metrics were collected between two periods of time defined as P1- Pre Covid (Feb-Jun 2019) and P2 Post-Covid (Feb-Jun 2020) and compared. Statistical analysis was performed using the Chi-Square test and the Z-test for two independent samples. Results: The percentage of performed procedures amongst all clinical visits increased in P2 (45% vs 29% p < 0.001). There was an increase in the percentage of new patients scheduled within 5- and 14-days during P2 (71 % vs 46%, p < 0.001, and 55 % vs 41%, p < 0.001) respectively. Total charges and RVUs decreased in P2 but the overall payments were higher compared to P1. This increase in revenue was due to a higher income generated by procedures. CGCAHPS and Press Ganey scores improved in P2 across all domains representing patient experience. This improvement was statistically significant for “Recommend this provider office” (90% vs 85.7% p = 0.01), “Access overall” (56% vs 49% p = 0.02), and “Moving through your visit overall” (59% vs 51% p = 0.007). Conclusions: Our data suggests that transitioning the urology clinics into a space that is mainly dedicated to outpatient procedures can represent a model that improves the patient's access to care and clinical experience, as well as strategically bolstering financial revenues. This is a more efficient care model that could replace current practice and represent the future of outpatient Urology. (Table Presented).

COVID-19 pandemic results in decreased non-urgent urologic-related presentations to the ED

Introduction & Objective: Urologic-related visits to the emergency department (ED) are variable in their acuity, ranging from non-emergent to life-threatening. We sought to evaluate trends in urologic presentations to the ED during the COVID-19 pandemic at a tertiary academic institution in the United States to determine the differences in frequency between urgent and nonurgent visits and further elucidate delayed access to urologic care. Methods: A retrospective analysis was performed comparing the frequency and type of urologic-related ED visits at our institution in January-April 2019 to those in January-April 2020 during the initial pandemic phase. 1,838 urologic presentations between the two-time intervals were organized by diagnosis and divided by acuity into urgent and non-urgent categories. Interrupted time series regression models were used to determine how urologicrelated ED visits changed due to the COVID-19 pandemic. Results: The total number of urologic related ED visits by type for each time interval is demonstrated in Table 1. There was a statistically significant drop in total urologic-related ED visits after the COVID-19 pandemic began, with a drop in total visits of approximately 76 per month (p = 0.002). There was no difference in the number of urgent ED visits due to the COVID-19 pandemic (p = 0.13). However, there was a statistically significant decrease in non-urgent ED visits, with a decrease of 68 visits per month (p = 0.002). When examining the individual visit types, there were no differences in visit volume except for hematuria and nephrolithiasis/ureterolithiasis visits. There was a statistically significant reduction in hematuria-related ED visits, with a reduction in visits of approximately 11 per month (p = 0.03). Similarly, there was a statistically significant decline in nephrolithiasis/ ureterolithiasis-related ED visits, with a decline of approximately 28 visits per month (p = 0.04). Conclusions: The COVID-19 pandemic coincided with a significant decrease in the number of non-urgent urologic presentations to our institution's ED. Specifically, there was a significant decrease in the number of patients presenting with hematuria and nephrolithiasis-related issues. There was no significant decrease in the number of urgent urologic consults. Follow up study is indicated to investigate the effect of delayed evaluation for these non-urgent urologic diagnoses. (Table Presented).