The impact of the COVID-19 pandemic on urological care in Poland - Post-COVID resilience scenarios and recommendations for healthcare system: A national population-based modelling study.

IntroductionOur aim was to assess the time required to recover the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak in 2020 and 2021 in Poland, to indicate the most affected procedures, and to estimate the recovery time after a likely fourth lockdown.Material and methodsThe data aggregates contained the number of patients who underwent specific urological procedures classified in the ICD-9, performed from January 2009 to October 2019, acquired in granulation per month and per single voivodeship, and obtained by healthcare providers such as hospitals, ambulatory units, and primary care facilities. Using the model, we obtained the time required to discharge the excessive load on the healthcare system and the median wait time in the post-lockdown period. We validated the model based on the data aggregates from March to October 2020.ResultsLeaving the capacity of the most affected procedures unaltered, or increasing it by 20%, would not reduce the backlog of patients waiting to receive care after the third lockdown. The consequences of a feasible fourth lockdown would cause the necessity of a post-lockdown increase in capacity by more than 50%.ConclusionsThe availability of the most affected procedures will never achieve the pre-pandemic state without increasing the hypothetical surgical capacity of urological procedures that were suspended due to lockdowns caused by the SARS-CoV-2 outbreak. These procedures require taking special steps to unblock the urological healthcare system and allow patients continuous access to treatment.

A Study on Post Operative Pain Assesment on Arrival Using Vas Score among Urological Procedures after general Anaesthesia vs. Regional Anaesthesia

Background: A Visual Analogue Scale (VAS) is a measurement that tries to measure a characteristic or attitude that is believed to range across a continuum of values and cannot easily be directly measured [1]. The 100 mm visual analogue scale (VAS) score is widely used to measure pain intensity after surgery. The main objective here is to compare the effectiveness and safety of general anaesthesia (GA) vs. regional anaesthesia (RA) in urological procedures with the help of VAS. Methods: We enrolled a sequential, unselected cohort of fifty-two patients on arrival from surgery and used a VAS to quantify pain intensity. We compared changes in the VAS among patients who received either GA or RA for urological procedures. Patient’s comorbidities, vitals, pain visual analogue scale (VAS) are evaluated. Intraoperative and post-operative complications were recorded. Results: Vital parameters were maintained at safe values throughout the procedure in both groups. Visual analogue pain score was lower in regional anaesthesia till one hour mark of post-operative period as compared with GA cluster (P <0.05). Patients in regional anaesthesia recorded lower consumption of analgesics during the post-operative day-0 as compared with GA cluster (P < 0.05). Post-operative shivering was higher in RA cluster than GA cluster (8% vs. 2%) whereas nausea and fever was higher in GA cluster than RA cluster (5% vs. 2% and 4% vs. 1% respectively). However, Patients in GA cluster recorded higher overall satisfaction scores than RA cluster. Conclusion: Both GA and RA were effective and safe in Percutaneous Nephrolithotomy. It is observed that PCNL under RA was associated with significantly shorter operative time and hospital stay. Furthermore, postoperative pain scores were low, lower nausea and/or vomiting, and reduced analgesic requirements were noted in the RA group. However, GA provides heaps of satisfaction for patients.

Urological surgery

This chapter discusses the anaesthetic management of urological surgery. Surgical procedures covered include cystoscopic procedures; transurethral resection of the prostate (TURP) (including TURP syndrome); transurethral resection of bladder tumour (TURBT); prostatectomy (including radical prostatectomy); nephrectomy and partial nephrectomy; radical cystectomy; robot-assisted laparoscopic prostatectomy (RALP); percutaneous stone removal; extracorporeal shockwave lithotripsy, testicular surgery and renal transplantation. It includes pertinent anaesthetic features for a series of additional miscellaneous urological procedures.

Where are the paediatric patients with testicular torsion during the COVID-19 pandemic?

Introduction The Irish people were put on lockdown in mid-March 2020 due to concern of the spread of coronavirus. With these societal changes came a notable reduction in emergency department attendance. Our aim was to analyse emergency urological procedures performed during the COVID-19 era versus the previous year. Methods A retrospective review of theatre logbooks was undertaken comparing numbers of emergency urological procedures performed between 1 March 2020 and 31 May 2020 (i.e. the COVID-19 era) with the corresponding 3-month period in 2019. Results A total of 173 cases were analysed between the two time periods. Similar overall numbers of cases were performed in 2019 (n = 90) and 2020 (n = 83). In particular, similar patient case numbers are also noted in both scrotal explorations (13 vs 9) and ureteric stone surgeries (69 vs 70). However, orchidectomies for testicular cancers were reduced by 63% (3/8). On further analysis of the scrotal exploration group, only 3 were performed in the period after lockdown regulations were instated. Conclusion Whilst patients with ureteric colic continue to present, those with acute testis pain requiring exploration attended less frequently, raising the possibility of undiagnosed testicular torsion in the community.

A case report of forgotten double J stent with giant calculus formation from the renal pelvis to the bladder

Double j stent is commonly used in urological procedures. Its main purpose is to afford the sufficient drainage from the renal pelvis to the urinary bladder. Following increased usage of double-J stent, several consequences associated to it have been reported. In this work, we report on a case of “forgotten” double j stent for 1 year in a 32-year-old male patient who visited emergency department with bilateral flank pain, fever, and vomiting for a duration of 3 days. A double-J stent was detected in the plain abdominal X-ray. It was also observed that a 20 × 15 mm stone has impacted the left renal pelvis. Therefore, two operations were performed successfully until the full recovery of the patient. Hence; the main aim of this paper is to increase awareness about the potential complications of “forgotten” double J Stent.

Prediction of post radical nephrectomy complications based on patient comorbidity preoperatively

Objectives: Comorbidity along with tumor and patient characteristics is taken into account when deciding for the surgical treatment of renal cell carcinoma (RCC). Comorbidity has also been used as an independent predictive factor for postoperative complications of several major urological procedures including radical nephrectomy for RCC. The aim of the present study was to objectively evaluate the association between comorbidity and postoperative complications after radical nephrectomy for RCC, using standardized systems to grade both comorbidity and severity of postoperative complications. Materials and methods: Clinicopathological data of 171 patients undergoing open radical nephrectomy for lesions suspected of RCC were prospectively recorded for a period of 3 years. Comorbidity was scored using the Charlson Comorbidity Index (CCI) while postoperative complications were graded according to the Clavien-Dindo system.Results: Patients were predominantly males (59.1%); their age ranged from 35 to 88 years (mean ± SD: 63.6 ± 11.9 yrs) with 50.8% of them being ≤ 65 yrs. CCI ranged from 0 to 8 with the majority (85.3%) scoring ≤ 2. The procedure was uncomplicated in 57.3% cases; 10 patients suffered major (grade III/IV) complications and 4 patients died within the 40 days postoperative period. CCI correlated with the manifestation of any postoperative complication, Clavien ≥ 1, OR (95% CI): 1.47 (1.09-1.96), p = 0.011 and the occurrence of severe complications, Clavien > 2. OR (95% CI): 1.29 (1.01-1.63), p = 0.038. Conclusions: The present prospective study showed that considerable complications occur in patients with major comorbidities. CCI is easily calculated and should be incorporated in preoperative consultation especially in cases of elder patients with severe comorbidity and favorable tumor characteristics where less invasive interventions or even active surveillance could be applied.

Special Issue ‘Minimally Invasive Urological Procedures and Related Technological Developments’

The landscape of minimally invasive urological intervention is changing[...]