Estado actual y evolución del manejo de la patología funcional y del suelo pélvico en los hospitales de la Comunidad de Madrid / Evolution and current status of the management of functional and pelvic floor pathology in the hospitals of the Community of Madrid

Introducción y objetivo Las disfunciones del suelo pélvico (DSP) incluyen un amplio número de patologías sujetas a una alta variabilidad en su manejo según los medios y capacitación de los centros y sus profesionales. El objetivo del estudio es constatar y describir la variabilidad clínica en el manejo de las DSP en los servicios de Urología de los centros sanitarios públicos de la Comunidad de Madrid, así como la dotación de medios disponibles en la actualidad en dichos centros. Material y métodos Encuesta realizada en septiembre de 2021 dirigida a facultativos especialistas en Urología Funcional de los hospitales públicos de la Comunidad de Madrid. Esta se basa en una encuesta realizada en 2011 por Díez et al. con la misma finalidad. Se analizaron las características asistenciales de los distintos centros y el manejo de las principales patologías funcionales del suelo pélvico. Se compararon los resultados con los de la encuesta de 2011 para las preguntas equiparables. Resultados El número de Unidades de Suelo Pélvico (USP) ha aumentado notablemente en los últimos 10 años. El uso de dispositivos ajustables en el tratamiento de la IUE masculina se ha extendido en los centros encuestados. La colposacropexia laparoscópica/robótica se ha convertido en el tratamiento de referencia del prolapso de órganos pélvicos (POP). Conclusiones Las USP multidisciplinares son el modelo a seguir para el manejo de las DSP. Se constata la variabilidad en el manejo de la incontinencia urinaria, POP, el síndrome de dolor vesical y la neuropatía del nervio pudendo (AU)

Introduction and objective Pelvic floor dysfunction (PFD) includes a large number of pathologies subjected to a significantly varied management, depending on the hospitals’ resources and educational levels of their professionals. The aim of this study is to determine and describe the clinical variability in the management of PFD in the urology departments of the public health centers of the Community of Madrid, as well as the resources currently available in these centers. Material and methods The survey was carried out in September 2021 and was addressed to physicians specialized in functional urology in the public hospitals of the Community of Madrid. This survey is based on the one performed in 2011 by Díez et al. for the same purpose. The characteristics of the healthcare services provided in the different centers and the management of the main functional pathologies of the pelvic floor were analyzed. The results were compared with those of the 2011 survey for equivalent questions. Results The number of Pelvic Floor Units (PFUs) has remarkably increased in the last 10 years. The use of adjustable devices in the treatment of male SUI has become widespread in the centers included in the survey. Laparoscopic/robotic sacrocolpopexy has become the gold standard treatment for pelvic organ prolapse (POP). Conclusions Multidisciplinary PFUs represent the reference framework for the management of PFD. Variability in the management of urinary incontinence, POP, bladder pain syndrome and pudendal nerve neuropathy is recognized (AU)

Desarrollo e implementación de una unidad de inmunoterapia en un servicio de urología / Development and implementation of an immunotherapy unit in a urology department

Introducción La inmunoterapia está revolucionando el tratamiento del cáncer, siendo los anticuerpos monoclonales dirigidos contra moléculas reguladoras del punto de control la terapia más ampliamente utilizada en la actualidad. Un total de seis fármacos inhibidores del punto de control inmunitario (CPI) han sido aprobados por la U.S. Food and Drug Administration (FDA) y por la European Medicines Agency (EMA) para su uso en diversos tumores sólidos del aparato genitourinario. Material y métodos Se revisó la literatura y se analizó la metodología y experiencia propia adquirida para instaurar el tratamiento con CPI en un servicio de Urología. Resultados Se describen los requisitos recomendables desde el punto de vista formativo, logístico y procedimental para implementar una unidad de inmunoterapia en un servicio de Urología que permita ofrecer con seguridad el tratamiento experto con CPI a los pacientes con tumores genitourinarios. Conclusiones El cumplimiento del programa propuesto garantiza la administración segura de CPI en un entorno hospitalario (AU)

Introduction Immunotherapy is revolutionizing cancer treatment, with monoclonal antibodies directed against checkpoint regulatory molecules currently being the most widely used therapy. A total of six immune checkpoint inhibitor (CPI) drugs have been approved by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for use in various solid tumors of the genitourinary tract. Material and methods the literature is reviewed and the methodology, as well as our own experience, are analyzed to establish treatment with CPI in a urology department. Results The requirements recommended in terms of training, logistics and procedure are described in order to safely offer expert treatment with CPI to patients with genitourinary tumors. Conclusions Compliance with the proposed program ensures safe administration of immune checkpoint inhibitors in a hospital setting (AU)

Impacto de la pandemia en la actividad de las unidades de cirugía reconstructiva urológica y de andrología en España durante el estado de alarma (COVID-19) en 2020: resultados de una encuesta nacional / The impact of COVID-19 pandemic on reconstructive urologic surgery and andrology Spanish units’ practice during the state of alarm in 2020: National survey

Introducción: El estado de alarma debido a la COVID-19 revolucionó la actividad asistencial y quirúrgica. Dentro de la enfermedad urológica, aquellas consideradas «demorables» como la andrológica y la reconstructiva sufrieron un retraso considerable en su atención. Material y métodos: En mayo de 2020, tras haber superado casi la primera ola de la pandemia y en pleno estado de alarma, se envió una encuesta con 24 ítems a 120 urólogos integrados en los Grupos de Cirugía Reconstructiva Urológica y Andrología de la Asociación Española de Urología (AEU) para conocer la repercusión asistencial sobre la actividad clínica y quirúrgica en ambas subespecialidades. Resultados: Se alcanzó una tasa de respuesta del 75,8% con 91 encuestas recibidas. Previo al estado de alarma, el 49,5% disponía de uno a 2 quirófanos semanales, el 71,4% afrontaba una lista de espera quirúrgica de entre 3 y 12 meses, y el 39,6% atendía entre 20 y 40 pacientes semanales en consulta. Durante el estado de alarma, el 95,6% recibió directrices sobre cirugías a realizar, priorizando la cirugía urgente y la oncológica. En el 85,7% de los centros no se realizó ninguna cirugía andrológica ni reconstructiva. Alrededor del 50% de las consultas no fueron presenciales, recurriendo a la telemedicina (teléfono o e-mail) en la mayoría de los casos. Conclusiones: Las repercusiones de la pandemia sobre las enfermedades andrológicas y las candidatas a cirugía reconstructiva fueron muy importantes. Tras casi 2 años del inicio de la pandemia, aún queda por determinar el verdadero impacto final en nuestro sistema sanitario (AU)

Introduction: In Spain the state of alarm secondary to COVID-19 dramatically changed the medical and surgical assistance activity of other pathologies. Regarding urological pathologies, those considered as «non-urgent» (andrology and reconstructive surgery) were postponed or even unattended. Material and methods: In May 2020, once the first COVID-19 wave was almost over and still in the state of alarm, a 24-item survey was sent to 120 urologists from the Andrology Group and the Urologic Reconstructive Surgery Group of the Spanish Urological Association (AEU). Its aim was to determine the impact on clinical and surgical practice in both subspecialties. Results: We observed a response rate of 75.8% with 91 answered surveys. Before the state of alarm, 49.5% of urologists had 1-2 weekly surgical sessions available, surgical waiting list was 3-12 months for the 71.4%, and 39.6% attended between 20-40 patients weekly in office. During the state of alarm, 95.6% were given any kind of surgical guidelines, prioritizing emergency and oncologic pathologies. In the 85.7% of the hospitals neither andrology nor reconstructive surgeries were performed. In office, around 50% of patients were attended not on-site, most of them through telemedicine (phone calls and e-mails). Conclusions The negative pandemic implications in relation to the andrology and reconstructive surgery pathologies were truly important. After almost 2 years from the start of the pandemic, the true final impact on our health system has yet to be determined (AU)

Nosocomial SARS-CoV-2 infection in urology departments: Results of a prospective multicentric study.

OBJECTIVE: To evaluate the coronavirus disease 2019 perioperative infection rate and mortality rate of patients undergoing urological surgeries during the early pandemic period in Spain. METHODS: This was a non-interventional multicenter prospective study carried out from 9 March to 3 May 2020 in two urology departments in Madrid, Spain. Clinical, microbiological and radiological data of patients who underwent surgery were collected from computerized medical records. RESULTS: A total of 148 patients were included in the study, and 141 were analyzed for nosocomial infection risk, after excluding previous and concomitant severe acute respiratory syndrome coronavirus type 2 infections. Elective surgeries represented 76.6% of the procedures, whereas emergent surgeries represented 23.4%. Preoperative screening was carried out with polymerase chain reaction test in 34 patients, all were negative. A total of 14 patients also had chest X-ray (not suspicious in all cases). Three patients (2.1%) developed severe acute respiratory syndrome coronavirus type 2 nosocomial infection (symptoms developed between the third day after surgery to the 14th day after hospital discharge). Time from admission to a compatible clinical case was 5.5 days (4-12 days). Two patients underwent surgery with concomitant diagnosis of coronavirus disease. The mortality rate due to severe acute respiratory syndrome coronavirus type 2 infection is 0.7%, and the specific mortality rate in patients undergoing surgery with community-acquired coronavirus disease 2019 infection was 50% (1/2). CONCLUSIONS: The nosocomial severe acute respiratory syndrome coronavirus type 2 infection rate was low in patients undergoing urological surgical procedures during the peak of the pandemic in Madrid. With appropriate perioperative screening, urological surgical activity can be carried out in safety conditions.

Preliminary assessment of patient and physician satisfaction with the use of teleconsultation in urology during the COVID-19 pandemic.

PURPOSE: Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic. METHODS: From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression. RESULTS: Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03). CONCLUSION: Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.

Changes in Urology After the First Wave of the COVID-19 Pandemic.

The COVID-19 pandemic has changed the world. Urology needs to overcome these challenges. Our duty is to provide care under any circumstances and our privilege is to re-examine and advance our field. The use of novel communication and health technologies will ensure safety while maintaining high-quality care.

The impact of COVID-19 pandemic on urological emergencies: a single-center experience.

PURPOSE: COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. METHODS: we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models. RESULTS: The final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096-6.757, p = 0.0297) was a significant predictor of admission. CONCLUSIONS: Urgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.

Urological service provision during the COVID-19 period: the experience from an Irish tertiary centre.

PURPOSE: Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. METHODS: Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. RESULTS: Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. CONCLUSION: Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

The Impact of COVID-19 Pandemic on Urological Emergencies: A Multicenter Experience on over 3,000 Patients.

OBJECTIVE: COVID-19 pandemic represents a dramatic challenge for healthcare systems worldwide, and it also affects daily urological practice. After China and Italy, Tessin (Switzerland) has been hit the hardest, due to its close proximity to Lombardy and the high number of frontier workers in the area. Our objective was to share with the scientific community how, during the COVID-19 period, there has been a huge modification in urological emergencies throughout all hospitals included in the Ente Ospedaliero Cantonale (EOC). METHODS: We retrospectively reviewed urgent urological consultations requested by the emergency department (ED) of the 4 public hospitals located in Tessin belonging to EOC in the 3-month period between February 15 and May 15, 2020, and compared them to the 2 previous years cases within the same time frame (February 15 to May 15, 2018 and 2019). The number of daily consultations, urgent invasive procedures performed, and admissions were evaluated. RESULTS: The final sample resulted in 594 consultations performed in 2020, 974 in 2018, and 974 in 2019. A higher number of daily consultations were performed during 2018 and 2019. The number of daily admissions dropped consistently during the COVID-19 pandemic (737 vs. 392). CONCLUSIONS: Our multicenter study aimed to quantify changes in urgent urological care in Tessin in the midst of the COVID-19 pandemic. Urgent urology practice was dramatically affected with a remarkable reduction in urgent urological consultations, whereas a higher risk of admissions was observed in 2020, due to the severity of the patients.

Repercusión de la pandemia COVID-19 sobre la actividad quirúrgica de Urología Pediátrica: análisis de las complicaciones posquirúrgicas según la clasificación de Clavien-Dindo / Impact of the COVID-19 pandemic on the surgical activity of Pediatric Urology: analysis of postoperative complications according to the Clavien-Dindo classification

INTRODUCCIÓN Y OBJETIVO: La coronavirus disease 2019 (COVID-19) ha ocasionado una pandemia de repercusión mundial que obligó a tomar medidas sociopolíticas, como la declaración del estado de alarma en España. Paralelamente se llevó a cabo la reestructuración de las actividades e infraestructuras médico-quirúrgicas pediátricas, con la consecuente suspensión de la actividad quirúrgica no urgente de Urología Pediátrica. Analizamos la repercusión de la pandemia COVID-19 sobre la actividad quirúrgica en una sección de Urología Pediátrica, así como las complicaciones quirúrgicas, según la clasificación de Clavien-Dindo. MATERIALES Y MÉTODOS: Se procedió a la revisión sistemática de los datos epidemiológicos, clínicos y quirúrgicos, incluyendo las complicaciones y reingresos de todos los pacientes intervenidos en la sección de Urología Pediátrica desde la declaración del estado de alarma hasta el levantamiento del mismo. Para su estudio se procedió a la división en cinco bloques temporales acorde a las fases de desescalada. RESULTADOS: Se realizaron 49 intervenciones quirúrgicas en 45 pacientes (ocho previos a la implantación de las fases de desescalada). La patología con prioridad alta fue la más frecuente en las primeras fases, siendo la estenosis de la unión pieloureteral (EPU) la más prevalente. Se registraron cuatro complicaciones (8,8%), ninguna de ellas de origen respiratorio. CONCLUSIONES: Las recomendaciones de la EAU para la reanudación de la actividad quirúrgica han permitido una correcta, segura y gradual transición al ritmo quirúrgico habitual en Urología Pediátrica. La clasificación de Clavien-Dindo es útil y válida para su aplicación en esta sección. No se han registrados complicaciones respiratorias que pudiesen ser atribuibles a la situación pandémica

INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) has caused a pandemic of global impact that forced social-political measures to be taken, such as the declaration of the state of alarm in Spain. At the same time, the reorganization of the pediatric medical-surgical activities and infrastructures was carried out, with the consequent suspension of the non-urgent surgical activity of Pediatric Urology. We analyzed the impact of the COVID-19 pandemic on surgical activity in a Pediatric Urology division, as well as surgical complications according to the Clavien-Dindo classification. MATERIALS AND METHODS: A systematic review of epidemiological, clinical and surgical data was carried out, including complications and readmissions of all patients operated on in the division of Pediatric Urology within the duration of the state of alarm. Five time periods have been created according to the de-escalation phases. RESULTS: Forty-nine surgical procedures were carried out on 45 patients (8 prior to the implementation of the de-escalation phases). High priority pathologies were the most frequent in the first phases, being the ureteropelvic junction (UPJ) obstruction the most prevalent. Four complications were recorded (8.8%), none of them were respiratory. CONCLUSIONS: The EAU recommendations for the resumption of surgical activity have allowed a correct, safe and gradual transition to the routine surgical activity in Pediatric Urology. The Clavien-Dindo classification is useful and valid for application in this division. No respiratory complications have been reported that could be attributable to the pandemic situation

Evaluación de las tendencias y presentación clínica de pacientes con cólico nefrítico que acuden al servicio de urgencias durante la era pandémica del COVID-19 / Assessment of trends and clinical presentation in the emergency department of patients with renal colic during the COVID-19 pandemic era

INTRODUCCIÓN: Nuestra hipótesis es que la pandemia por COVID-19, y el estado de alarma impuesto por los gobiernos, pueden haber retrasado las visitas a urgencias por cólicos nefríticos, debido al miedo a contagiarse en los centros sanitarios. Este atraso en acudir a los servicios de urgencias puede llevar a un empeoramiento clínico y aumentar las complicaciones relacionadas con la enfermedad o el tratamiento recibido. MATERIAL Y MÉTODOS: Realizamos una revisión retrospectiva de 3 centros hospitalarios en España e Italia. Fueron incluidos pacientes atendidos en el servicio de urgencias por cólico renal (unilateral o bilateral) secundario a litiasis confirmadas en pruebas de imagen durante los 45 días previos y posteriores a la declaración del estado de alarma de cada país. Se recolectaron datos demográficos, síntomas y signos de presentación, análisis de sangre y orina, pruebas de imagen, y manejo terapéutico. El análisis estadístico se realizó entre dos grupos, Grupo A: pacientes que acudieron antes de la declaración del estado de alarma y Grupo B: pacientes que acudieron tras la declaración del estado de alarma. RESULTADOS: Un total de 397 pacientes que acudieron a urgencias por cólicos nefríticos secundarios a litiasis fueron incluidos en el estudio, 285 (71,8%) en el Grupo A y 112 (28,2%) en el Grupo B (p < 0,001). Un total de 135 (47,4%) en el Grupo A y 63 (56,3%) en el Grupo B (p = 0,11) admitieron haber pospuesto su búsqueda de atención médica urgente. En el momento de la valoración inicial, no se encontraron diferencias entre ambos grupos en los niveles de creatinina sérica, leucocitosis, fiebre, oliguria, dolor, o hidronefrosis. Además, no se observaron diferencias en relación con la estancia media, ingreso en el servicio de urología, o necesidad de tratamientos invasivos. CONCLUSIÓN: Nuestros resultados muestran una disminución significativa de atenciones en urgencias por cólicos nefríticos tras la declaración del estado de alarma en España e Italia. A diferencia de otros estudios publicados recientemente, no encontramos diferencias en la estancia media, ingreso al servicio de urología, o necesidad de tratamientos invasivos en pacientes que se presentaron antes y después del estado de alarma

INTRODUCTION: We hypothesized that the recent COVID-19 pandemic may lead to a delay in renal colic patients presenting to the Emergency Department due to the fear of getting infected. This delay may lead to a more severe clinical condition at presentation with possible complications for the patients. MATERIAL AND METHODS: Retrospective review of data collected from three institutions from Spain and Italy. Patients who presented to Emergency Department with unilateral or bilateral renal colic caused by imaging confirmed urolithiasis during the 45 days before and after each national lockdown were included. Data collected included patients’ demographics, biochemical urine and blood tests, radiological tests, signs, symptoms and the therapeutic management. Analysis was performed between two groups, Group A: patients presenting prior to the national lockdown date; and Group B: patients presenting after the national lockdown date. RESULTS: A total of 397 patients presented to Emergency Department with radiology confirmed urolithiasis and were included in the study. The number of patients presenting to Emergency Department with renal/ureteric colic was 285 (71.8%) patients in Group A and 112 (28.2%) patients in Group B (p < 0.001). The number of patients reporting a delay in presentation was 135 (47.4%) in Group A and 63 (56.3%) in Group B (p = 0.11). At presentation, there were no statistical differences between Group A and Group B regarding the serum creatinine level, C reactive protein, white blood cell count, fever, oliguria, flank pain and hydronephrosis. In addition, no significant differences were observed with the length of stay, Urology department admission requirement and type of therapy. CONCLUSION: Data from our study showed a significant reduction in presentations to Emergency Department for renal colic after the lockdown in Spain and Italy. However, we did not find any significant difference with the length of stay, Urology department admission requirement and type of therapy

Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas / Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases

INTRODUCCIÓN: La pandemia por SARS-CoV-2 ha cambiado la práctica urológica a nivel mundial. Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urología de un hospital terciario, a lo largo de diferentes fases epidemiológicas. MÉTODOS: Estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo. Según la organización hospitalaria, distinguimos 3 periodos: durante las primeras 2 semanas no hubo cambios (1.er periodo), en las 7 semanas siguientes solo se realizaron intervenciones urgentes previa extracción de exudado nasofaríngeo (2.o periodo), y tras el 4 de mayo se reanudó la cirugía electiva aplicando un protocolo de cribado multidisciplinar (3.er periodo). Las variables demográficas y basales, las quirúrgicas y perioperatorias, así como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3). El seguimiento telefónico se realizó al menos 3 semanas tras el alta hospitalaria. RESULTADOS: Se realizaron 103 cirugías urológicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1.er periodo. El diagnóstico era conocido en un paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 días tras la intervención y 16,6 días tras el alta. Cuatro de 7 pacientes trasplantados resultaron afectados. Se registraron 3 muertes por la enfermedad: una mujer de 69 años trasplantada y 2 varones mayores de 80 años con comorbilidades y alto riesgo anestésico a los que se realizó drenaje de absceso retroperitoneal y cirugía retrógrada intrarrenal, respectivamente. CONCLUSIONES: La infección por SARS-CoV-2 afectó principalmente a trasplantados renales o pacientes añosos con alto riesgo anestésico, durante las 2 primeras semanas de la pandemia. Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad

INTRODUCTION: The SARS-CoV-2 pandemic has changed the urological practice around the world. Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases. METHODS: Observational, cohort study including all patients undergoing surgery from March 1 to May 14. According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st. period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd. period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd. period). Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner. Telephone follow-up was initiated at least 3 weeks after hospital discharge. RESULTS: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st. period. The diagnosis was already known in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16,6 days after discharge. Of seven transplant patients, four got the infection. Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively. CONCLUSIONS: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic. After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved

Evaluación de la teleconsulta en el paciente urológico durante la pandemia COVID-19 / Evaluation of teleconsultation system in the urological patient during the COVID-19 pandemic

INTRODUCCIÓN: La pandemia global de COVID-19 ha provocado una rápida implantación de la telemedicina, pero existe escasa información sobre la satisfacción percibida por el paciente como alternativa a la asistencia presencial. OBJETIVO: Se evalúa la satisfacción del paciente urológico con la teleconsulta durante la pandemia COVID-19. MATERIAL Y MÉTODOS: Estudio observacional, prospectivo transversal, no intervencionista, mediante encuesta telefónica durante el periodo considerado pico de pandemia (marzo-abril 2020). Se realiza una encuesta de calidad compuesta por 11 preguntas sobre la atención urológica durante la pandemia COVID-19 por los facultativos, seleccionando una muestra representativa de los pacientes atendidos en el periodo por teleconsulta. RESULTADOS: Doscientos pacientes fueron contactados telefónicamente para responder a una encuesta de calidad sobre teleconsulta. La distribución de pacientes encuestados entre las consultas monográficas fue homogénea entre el número de consultas citadas en el periodo, requiriendo el 18% de ellos ayuda por familiar. El 60% de los pacientes evitaron acudir a un centro médico durante la pandemia. El 42% de los pacientes encuestados tenían cancelada alguna prueba complementaria, el 59% alguna consulta médica, el 3,5% tratamientos y el 1% intervenciones. El 10% apreciaron un empeoramiento de su sintomatología urológica durante el confinamiento. La resolución subjetiva de la consulta por el facultativo fue alcanzada en el 72% de los casos, siendo la teleconsulta por el urólogo habitual en el 81%. El grado de satisfacción global con la teleconsulta fue de 9 (RIQ 8-10), considerando la teleconsulta como una «opción de asistencia sanitaria» pasada la crisis sanitaria por el 61,5% de los encuestados. CONCLUSIÓN: La teleconsulta ha sido valorada con un alto grado de satisfacción durante la pandemia COVID-19, ofreciendo asistencia continuada a los pacientes urológicos durante la crisis sanitaria. La calidad percibida ofrece un campo de asistencia telemática opcional en pacientes seleccionados, que debe reevaluarse fuera de una situación de confinamiento

INTRODUCTION: The global pandemic of COVID-19 has led to rapid implementation of telemedicine, but there is little information on patient satisfaction of this system as an alternative to face-to-face care. OBJECTIVE: To evaluate urological patient satisfaction with teleconsultation during the COVID-19 pandemic. MATERIAL AND METHODS: Observational, prospective, cross-sectional, non-interventional study carried out by telephone survey during the period considered as the peak of the pandemic (March-April 2020). A quality survey composed of 11 questions on urological care provided by physicians during the COVID-19 pandemic was conducted, selecting a representative sample of patients attended by teleconsultation. RESULTS: Two hundred patients were contacted by telephone to answer a survey on the quality of teleconsultation. The distribution of patients surveyed among the specialized consultations was homogeneous with the number of consultations cited in the period; 18% of them required assistance from family members. Sixty percent of patients avoided going to a medical center during the pandemic. Of the surveyed patients, 42% had cancelled diagnostic tests, 59% had cancelled medical consultations, 3.5% had cancelled treatments and 1% had cancelled interventions. Ten percent reported a worsening of urological symptoms during confinement. According to physicians, consultations were effectively delivered in 72% of cases, with teleconsultation being carried out by their usual urologist in 81%. Teleconsultation overall satisfaction level was 9 (IQI8-10), and 61.5% of respondents consider teleconsultation as a «health care option» after the healthcare crisis. CONCLUSION: Teleconsultation has been evaluated with a high level of satisfaction during the COVID-19 pandemic, offering continuous care to urological patients during the healthcare crisis. The perceived quality offers a field of optional telematic assistance in selected patients, which should be re-evaluated in a period without confinement measures

Los cambios producidos durante el estado de alarma debido a la COVID-19 en un Servicio de Urología de un Hospital Universitario Terciario en Portugal / What has changed during the state of emergency due to COVID-19 on an Academic Urology Department of a Tertiary Hospital in Portugal

OBJETIVO: Comparar la actividad del Servicio de Urología de un Hospital Universitario Portugués durante el estado de alarma y el periodo equivalente del año anterior. Comparamos el número de consultas electivas y pruebas diagnósticas urológicas, el número y el tipo de cirugías electivas, así como las características demográficas de los pacientes y las principales causas de ingreso al Servicio de Urgencias (SU) de Urología durante los dos periodos mencionados. MATERIALES Y MÉTODOS: Los datos de 691 pacientes que acudieron a urgencias desde el 18 de marzo de 2020 hasta el 2 de mayo de 2020 -y del mismo periodo del año anterior- se recogieron del software medico institucional. Los datos recopilados fueron edad, sexo, fecha de visita al servicio de urgencias, derivación desde otros hospitales, color del triaje, causa del ingreso, diagnóstico al alta y la necesidad de cirugía de urgencia u hospitalización. Con la intención de identificar las asociaciones entre las variables demográficas y clínicas con el hecho de haber sido sometido a una cirugía de urgencia (variable), se aplicaron modelos de regresión logística. RESULTADOS: El análisis multivariante mostró asociación entre el sexo del paciente con el hecho de ser sometido a una cirugía, con una disminución del 65,6% en las probabilidades para el género masculino. El periodo (COVID versus sin-COVID) no mostró una asociación significativa con la cirugía. CONCLUSIÓN: Nuestro departamento experimentó una reducción importante en la actividad. También observamos una reducción de las causas urgentes para acudir a los servicios de urgencias considerados menos graves. El porcentaje de casos que requirieron cirugía de urgencia y hospitalización fue mayor durante el periodo COVID

OBJECTIVE: To compare the activity the Urology Department of a Portuguese Academic Hospital during the state of emergency and the equivalent period at the previous year. We compared the number of elective consultations and diagnostic urologic examinations, number and type of elective surgeries, as well as patients’ demographic characteristics and main causes of presentation to Urology Emergency Department (ED) during the two mentioned periods MATERIALS AND METHODS: Data from 691 patients coming to emergency department were collected from institutional clinical software from March 18 th 2020 to May 2 nd 2020 - and from the same period the previous year. Data collected were age, sex, day of the presentation to Emergency Department, referral from other hospitals, triage color, reason of admission, diagnosis of discharge, and the need for emergency surgery or hospitalization. In order to identify associations between demographic and clinical variables with having been submitted to an emergency surgery (outcome), logistic regression models were applied. RESULTS: Multivariable analysis showed an association of sex with being submitted to surgery, 65.6% decrease in the odds for the male gender. The period (COVID versus non-COVID) did not show a significant association with surgery. CONCLUSION: Our department experienced a noticeable activity reduction. We also observe a reduction in urgent causes to attend the ED considered less serious. The percentage of cases requiring emergency surgery and hospitalization was higher during COVID-period

Diseño de un protocolo asistencial para el reinicio de la cirugía urológica programada en periodo de epidemia COVID-19 / Design of an assistance protocol for the restart of scheduled urologic surgery in a COVID-19 epidemic period

OBJETIVO: Diseñar un protocolo asistencial para reiniciar la actividad quirúrgica programada en un servicio de Urología de un hospital de tercer nivel de la Comunidad de Madrid, de manera segura para nuestros pacientes y profesionales en el contexto de la epidemia por coronavirus SARS-CoV-2. MATERIAL Y MÉTODOS: Constituimos un grupo multidisciplinar que se encargó de analizar las diferentes recomendaciones de la literatura, organizaciones sanitarias nacionales e internacionales y sociedades científicas, así como de su aplicación a nuestro medio. Una vez reiniciada la cirugía programada, se está llevando a cabo un seguimiento de los pacientes intervenidos en cuanto a complicaciones relacionadas con COVID-19. RESULTADOS: Desde el reinicio de la actividad quirúrgica se han programado 19 pacientes, de los cuales 2 han sido suspendidos por presentar COVID-19, diagnosticado uno por PCR positiva para SARS-CoV-2, y otro por alteraciones analíticas y radiológicas compatibles con esta infección. En el seguimiento realizado no se han detectado complicaciones relacionadas con COVID-19, con una mediana de seguimiento de 10 días (4-14 días). CONCLUSIONES: Resultados preliminares indican que el protocolo diseñado para asegurar la correcta aplicación de medidas de prevención de transmisión de la infección por coronavirus está siendo seguro y efectivo

OBJECTIVE: Design a care protocol to restart scheduled surgical activity in a Urology service of a third level hospital in the Community of Madrid, in a safe way for our patients and professionals in the context of the SARS-CoV-2 coronavirus epidemic. MATERIAL AND METHODS: A multidisciplinary group reviewed the different recommendations of the literature, national and international health organizations and scientific societies, as well as their application to our environment. Once scheduled surgery has restarted, the patients undergoing surgery for complications related to COVID-19 are being followed up. RESULTS: Since the resumption of surgical activity, 19 patients have been scheduled, of which 2 have been suspended for presenting COVID-19, one diagnosed by positive PCR for SARS-CoV-2, and another by laboratory and imaging findings compatible with this infection. With a median follow-up of 10 days (4-14 days), no complications related to covid-19 were detected. CONCLUSIONS: Preliminary results indicate that the protocol designed to ensure the correct application of preventive measures against the transmission of coronavirus infection is being safe and effective

Urological surgery during SARS-CoV-2 pandemic. Descriptive analysis of the experience in a Urology Department across the pandemic phases. / Cirugía urológica durante la pandemia por SARS-CoV-2. Análisis descriptivo de la experiencia en un Servicio de Urología durante distintas fases epidemiológicas.

INTRODUCTION: The SARS-CoV-2 pandemic has changed the urological practice around the world. Our objective is to describe the outcomes presented by patients undergoing surgery in the urology department of a tertiary hospital, across the pandemic phases. METHODS: Observational, cohort study including all patients undergoing surgery from March 1 to May 14. According to the hospital organization, we identified three periods: there were no changes during the first two weeks (1st. period), the following seven weeks, when only urgent interventions were carried out after performance of nasopharyngeal swab test (2nd. period), and finally, elective surgery was resumed on May 4, after the implementation of a multidisciplinary screening protocol (3rd. period). Demographic, baseline, surgical and perioperative variables, as well as postoperative outcomes, were obtained in a retrospective (periods 1 and 2) and prospective (period 3) manner. Telephone follow-up was initiated at least 3 weeks after hospital discharge. RESULTS: 103 urological surgeries were performed, and 11 patients were diagnosed with COVID-19, 8 of them within the 1st. PERIOD: The diagnosis was already known in 1 patient, while the other 10 developed the disease in an average of 25 days after the intervention and 16,6 days after discharge. Of seven transplant patients, four got the infection. Three deaths were recorded due to the disease: a 69-year-old woman transplanted and two men over 80 with comorbidities and high anesthetic risk who underwent drainage of retroperitoneal abscess and retrograde intrarenal surgery, respectively. CONCLUSIONS: SARS-CoV-2 infection mainly affected renal transplant recipients or elderly patients with high anesthetic risk, during the first 2 weeks of the pandemic. After implementing preoperative PCR tests and a comprehensive screening protocol, cases were substantially reduced, and safe surgical procedures were achieved.