Yee CH. et al., 2021: Effect of SARS and COVID-19 outbreaks on urology practice and training
Yee CH, Wong HF, Tam MHM, Yuen SKK, Chan HC, Cheung MH, Yu ATO, Chiu Y, Chan NH, Leung LH, Ng ATL, Law DMC, Ng TL, Teoh JYC, Chiu PKF, Ng CF.
SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong.
Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong.
Department of Surgery, Alice Ho Miu Ling Nethersole Hospital, Hong Kong.
Department of Surgery, North District Hospital, Hong Kong.
Department of Surgery, United Christian Hospital, Hong Kong.
Department of Surgery, Tseung Kwan O Hospital, Hong Kong.
Department of Surgery, Tuen Mun Hospital, Hong Kong.
Department of Surgery, Pok Oi Hospital, Hong Kong.
Department of Surgery, Princess Margaret Hospital, Hong Kong.
Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong.
Department of Surgery, Kwong Wah Hospital, Hong Kong.
Department of Surgery, Queen Mary Hospital, Hong Kong.
Department of Surgery, Tung Wah Hospital, Hong Kong.
Department of Surgery, Caritas Medical Centre, Hong Kong.
Department of Surgery, Queen Elizabeth Hospital, Hong Kong.
Introduction: The objective was to investigate the changes in urology practice during coronavirus disease 2019 (COVID-19) pandemic with a perspective from our experience with severe acute respiratory syndrome (SARS) in 2003.
Methods: Institutional data from all urology centres in the Hong Kong public sector during the COVID-19 pandemic (1 Feb 2020-31 Mar 2020) and a non-COVID-19 control period (1 Feb 2019-31 Mar 2019) were acquired. An online anonymous questionnaire was used to gauge the impact of COVID-19 on resident training. The clinical output of tertiary centres was compared with data from the SARS period.
Results: The numbers of operating sessions, clinic attendance, cystoscopy sessions, prostate biopsy, and shockwave lithotripsy sessions were reduced by 40.5%, 28.5%, 49.6%, 44.8%, and 38.5%, respectively, across all the centres reviewed. The mean numbers of operating sessions before and during the COVID-19 pandemic were 85.1±30.3 and 50.6±25.7, respectively (P=0.005). All centres gave priority to cancer-related surgeries. Benign prostatic hyperplasia-related surgery (39.1%) and ureteric stone surgery (25.5%) were the most commonly delayed surgeries. The degree of reduction in urology services was less than that during SARS (47.2%, 55.3%, and 70.5% for operating sessions, cystoscopy, and biopsy, respectively). The mean numbers of operations performed by residents before and during the COVID-19 pandemic were 75.4±48.0 and 34.9±17.2, respectively (P=0.002).
Conclusion: A comprehensive review of urology practice during the COVID-19 pandemic revealed changes in every aspect of practice.
Hong Kong Med J. 2021 Feb 26. doi: 10.12809/hkmj208822. Online ahead of print. PMID: 33632937
This report on the effects and impact of covid-19 is highly interesting, partly because the Hong Kong-based authors also had experience from the SARS epidemic 2003-2004.
It is emphasized that the most delayed surgery was for BPH (39%) and ureteral stones (26%). These changes had an impact not only on the patients QoL but also on the training possibilities for young colleagues, particularly in their endourology education. The major reason was that priority was given to cancer surgery. For SWL the operating sessions were reduced by 38.5%.
It is important to note that transmission of virus is associated with respiratory aerosol-generating procedures and accordingly procedures that require general anaesthesia pose a specific risk.
From a general urological point of view, it is of note that covid-19 positive urine samples were recorded also when throat-swabs were negative. Moreover, the authors emphasize that shortage of PPE (personal protective equipment) was a world-wide problem.
This article describes the problems associated with the still on-going pandemic, but it is also important to look forward. In that perspective it is obvious that delayed medical and surgical procedures some day need to be taken care of. Moreover, it is also well recognized that patients with stones as well as other urological conditions postponed their contact with health care. This phenomenon everywhere has resulted in an accumulated bulk of patients necessary to take care of in an elective way when the pandemic is under full control. For stone removal at that time it seems reasonable to give preference to SWL which is a method that can be carried out without anaesthesia and thus save the anaesthetic service for patients who cannot be treated without anaesthesia.