Management of Female and Functional Urology Patients During the COVID Pandemic

Abstract

Context: Coronavirus disease 19 (COVID-19) has changed standard urology practice around the world. The situation is affecting not only uro-oncological patients but also patients with benign and disabling conditions who are suffering delays in medical attention that impact their quality of life. Objective: To propose, based on expert advice and current evidence where available, a strategy to reorganize female and functional urological (FFU) activity (diagnosis and treatment). Evidence acquisition: The present document is based on a narrative review of the limited data available in the urological literature on SARS-Cov-2 and the experience of FFU experts from several countries around the world. Evidence synthesis: In all the treatment schemes proposed in the literature on the COVID-19 pandemic, FFU surgery is not adequately covered and usually grouped into the category that is not urgent or can be delayed, but in a sustained pandemic scenario there are cases that cannot be delayed that should be considered for surgery as a priority. The aim of this document is to provide a detailed management plan for noninvasive and invasive FFU consultations, investigations, and operations. A classification of FFU surgical activity by indication and urgency is proposed, as well as recommendations adopted from the literature for good surgical practice and by surgical approach in FFU in the COVID-19 era.

Extensive impact of COVID‐19 pandemic on pelvic floor dysfunctions care: A nationwide interdisciplinary survey

“…4,10,11 Functional urogynecological procedures were mostly considered elective and in the low/intermediate group of priority. 4,[10][11][12][13][14] Although the term "elective" is open to various interpretations and deferment is rational when therapeutic alternatives with satisfactory outcomes are available, the extensive and often indiscriminate deprioritization of health-care services for PFD patients likely turned on largely unknown implications for patients' physical and psychological health. 12,[14][15][16] A substantial agreement emerged among respondents about the impact of the health-care suspension on the quality of life of PFD patients.…”

Interim Guidance for Urodynamic Practice during COVID-19 Pandemic

“…This article reviews the most recent guidelines focused on urology and urodynamic practice during the COVID-19 pandemic from the International Continence Society (7), European Association of Urology (8,9) and American Urological Association (10,11). Our present document is based on these guidelines and represents the recommendations of the Brazilian Society of Urology (SBU -Sociedade Brasileira de Urologia) regarding the practice of urodynamics during the COVID-19 pandemic in Brazil.…”

“…DO NOT perform urodynamic evaluation in suspected or confirmed SARS-COV-2 active infections. In patients who have already had the infection, urodynamics MAY BE PERFORMED after 14 days of hospital discharge (moderate or severe illness) or after 14 days of the onset of symptoms (mild illness), if the patient is totally asymptomatic (8). If in doubt, consider performing targeted SARS-CoV-2 testing of asymptomatic patients.…”

“…Patients must always wear a face mask. They should perform hand hygiene when entering and leaving the procedure room, by using alcohol hand--gel or thoroughly washing their hands for at least 20 seconds (7,8). The same instructions apply to a companion, if absolutely needed during the test.…”

“…Single-use gloves, aprons and masks are recommended during urodynamic evaluation for all the staff. Because the test may involve body fluids, contact and coughs, eye protection with a face visor or protection glasses should also be used (7,8,13).…”