Pediatric urology surgical practice in the time of COVID-19: Results from tertiary Saudi Arabia hospitals.

PURPOSE: Our study aimed to evaluate the effect of COVID-19 on pediatric urology practice in the Kingdom of Saudi Arabia (KSA). METHODS: Data of 10 tertiary hospitals in KSA were retrospectively analyzed. Data of outpatient department (OPD) visits and pediatric urology surgical procedures from January 1, 2019, to April 30, 2019, and from January 1, 2020, to April 30, 2020, were extracted. The primary outcome was to compare OPD visits and pediatric urology workload in the first third of 2020 versus 2019, where there was no curfew. The secondary outcome was to compare the same variables during the full curfew time, i.e., April 2020 versus April 2019. RESULTS: The number of OPD visits was lower in the first third of 2020 (7390 vs. 10,379 in 2019 P < 0.001). OPD visits in April 2020 were 78.6% lower than in April 2019, and teleclinics represented 850 (94.3%). Elective procedures in the first third of 2020 were 688, with a reduction rate of 34.3% compared to the same period of 2019 (P < 0.001). In April 2020, there were 18 elective surgeries, with a 91.4% decrease than in April 2019. Ureteric reimplantation, hypospadias, cryptorchidism, and circumcision stopped, while pyeloplasty (n = 14) and urolithiasis (n = 4) procedures had declined by 50% and 76.5%, respectively. Most of the procedures (71.8%) were day surgery. Emergency procedures were similar in the first third of 2020 (65 vs. 64 in 2019, P = 0.994) and declined in April 2020 by 6.7% versus April 2019. During the full curfew, the most common emergency intervention were cases with obstructive uropathy (42.8%), followed by torsion testis (28.6%), posterior urethral valve (14.3%), and urological trauma (14.3%). CONCLUSIONS: In KSA, the number of elective pediatric surgical procedures were reduced by >90%, while the number of emergency pediatric surgical procdures were similar during COVID-19 pandemic compared with non-COVID-19 time. Ureteric reimplantation, hypospadias repair, cryptorchidism, and circumcision procedures were postponed. Pyeloplasty and urolithiasis-related procedures were performed to prevent irreversible disease progression or organ damage. There was an increase in rate of teleclinic and day surgery to reduce the risk of COVID-19 infection.

Timing of orchidopexy at a tertiary center in Saudi Arabia: reasons for late surgery.

BACKGROUND: Orchidopexy should be performed during the first 18 months of life to decrease the risk of infertility and tumor formation. In our center, the timing of surgical correction varies depending on the availability of an operating room. OBJECTIVES: Evaluate whether orchidopexy performed for patients referred to our center is done within the recommended time period and to determine causes for delay. DESIGN: Retrospective descriptive study. SETTING: Pediatric urology department of a tertiary care center. SUBJECTS AND METHODS: We retrospectively reviewed the charts of patients charts who underwent orchidopexy at our center from 2000 to 2010. We assessed referral time and waiting list time, which were subdivided as follows: from referral to first visit and from first visit to surgery. We included patients younger than 14 years and excluded pa.tients with comorbidities that affected the timing of referral and surgi.cal treatment. MAIN OUTCOME MEASURES: Referral time period and waiting list time for surgical correction of patients presented with undescended testis. SAMPLE SIZE: 128 RESULTS: After exclusion of 32 patients because of comorbidities, we describe 128 who underwent surgery for cryptorchidism at our center. The median (interquartile range, minimum-maximum) for age at sur.gery was 46.7 months (24.4-83.4, 3.1-248.6]). The median (IQR) referral occurred at an age of 25.3 months (4.1-65.5). The median (IQR) waiting list time was 15.2 months (8.1-23.3). The median (IQR) waiting time from referral to the first visit was 4.1 months (1.0-8.2). The median wait.ing time from the first visit to surgery was 8.1 months (3.8-17.5). CONCLUSIONS: The age at the time of surgery at our center was far from ideal because of late referrals. A structured program offered by our National Health Service to educate referring physicians is necessary. Community health initiatives must emphasize prompt referral to reduce the impact of delayed surgery. LIMITATIONS: Lack of data on the type of referring physician (i.e., general practitioner, pediatrician, surgeon, urologist). CONFLICT OF INTEREST: None.

Robotic versus open pyeloplasty in pediatric patients: a single center experience in Saudi Arabia.

BACKGROUND: Robotic surgery in pediatric patients is performed in our center since 2013. This study aims to analyze the evolution of robot-assisted laparoscopic pyeloplasty (RALP) in our center to investigate its feasibility and safety compared with open pyeloplasty (OP) technique. METHODS: In this retrospective study, patients aged 2 to 14 years who underwent pyeloplasty procedure for ureteropelvic junction obstruction were divided into two groups according to the type of surgical approach (RALP and OP). The median age, weight, duration of the procedure, length of hospital stays, complication according to the Clavien grading system and success rates were recorded. We determined any trends in RALP activity, the length of hospital stay, and the patients' weight. We also compared the results of two equally divided periods (January 2015 to March 2016 and April 2016 to June 2017). RESULTS: Forty-one pyeloplasty were performed in this study. RALP and OP were performed in 26 (57.8%) and 15 (33.3%) cases, respectively. RALP was more utilized than OP in the second period (19 vs. 7). Comparing the two periods, a reduction in the median weight in the RALP group was observed (P=0.039); in the OP group, the weight remained almost unchanged (15 vs. 18 kg). The median duration of OP was shorter than that of RALP (P<0.04). The length of hospital stays reduced in the RALP group (P=0.013). CONCLUSIONS: RALP is safe and feasible and has a promising potential in pediatric urology. The rapid and favorable evolution in the studied indicators shows encouraging results as the indications for RALP are expanded and the length of hospital stay shortened.