The invisible impact of COVID-19: indirect mortality in urology

Sánchez-González, José Vicente; Colet, Oriol; Gómez-Palomo, Francisco; Perez-Ardavin, Javier; BERNAL, Adrián; Boronat, F

doi:10.23736/s2724-6051.20.04119-3

Cited by 3 publications

(2 citation statements)

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“…Given that the ongoing COVID-19 pandemic may limit hospital resources, these findings emphasize the importance of prioritizing prompt definitive treatment for patients with urothelial cancers. Such interventions should be performed expeditiously to achieve the best possible oncologic outcomes in patients with these malignancies, which are known to have a propensity for aggressive behavior and progression [ 41 ]. Therefore, it is imperative to avoid undue delays in surgical intervention and expedite treatment when possible, even during times of limited hospital resources [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of the Challenges of Urothelial Cancer Management during the COVID-19 Pandemic at a Single Academic Center in Romania

Barbos

Feciche²,

Bratosin

et al. 2023

Healthcare

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The COVID-19 pandemic caused major changes in the healthcare sector due to adaptations required to hospitalize and treat an impressive number of patients. This retrospective study intended to collect reliable information on urothelial cancer patients in Romania. The primary objective was to compare the pre-pandemic and pandemic periods to observe the differences that occurred in the management of patients with urothelial carcinoma. The secondary objective was to determine the risk factors for urothelial cancer progression in the study cohort correlated with the COVID-19 pandemic. All patients that were diagnosed and treated at our clinic with a diagnosis of urothelial carcinoma (transitional cell carcinoma) during 2019–2021 were included in the current study. A total of 1122 eligible unique cases were identified during the study period. The number of patients who underwent intervention in the pre-pandemic year was 421, followed by a 22.6% decrease in 2020 to 326 cases and a 13.1% increase in 2021 to 375 cases. The proportion of muscle-invasive bladder cancer (MIBC) cases was significantly higher during the pandemic years, from 30.5% MIBC cases in 2019 to 37.4% in 2020 and 39.4% in 2021, suggesting a delay in presentations during the pandemic. Stage III and IV (TNM) cases were significantly more frequent, even though approximately 40% of all patients were operated on in stage I. The number of cystectomies increased significantly, from 5.2% in 2019 and 4.3% in 2020 to 10.1% in 2021, while the number of elective surgeries decreased, although no significant difference was observed regarding the in-hospital mortality and disease progression at six months. Patients with stage III and IV at presentation had the highest likelihood of disease progression at six months (HR = 5.61). Distant invasion was the second highest risk factor (HR = 5.13), followed by MIBC type (HR = 2.49). Nevertheless, the duration of hospitalization and year of diagnosis during the COVID-19 pandemic were not significant risk factors for cancer progression at six months. It can be concluded that there was a significant delay in patient presentations in 2020, and we advocate for increased public health awareness for urothelial cancer and increased attention toward the screening and management of these patients in the following years.

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Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of the Challenges of Urothelial Cancer Management during the COVID-19 Pandemic at a Single Academic Center in Romania

Barbos

Feciche²,

Bratosin

et al. 2023

Healthcare

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“…Patients with medical emergencies often avoid hospital emergency departments because of the fear of COVID-19 contagion 143 . Urologists are also noticing a delay in consultation in some instances 144 , which could lead to increased morbidity and mortality, particularly in the field of oncology, in which the effect of missed diagnoses and delayed treatments might be devastating 145 . In the UK, 45% of patients with potential cancer symptoms (such as coughing up blood) did not contact their doctor in the first wave of the pandemic 146 .…”

Section: Outlook For Covid-19 Pandemicmentioning

confidence: 99%

The COVID-19 pandemic — what have urologists learned?

et al. 2022

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On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.

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