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A Systematic Review on Guidelines and Recommendations for Urology Standard of Care During the COVID-19 Pandemic

      Abstract

      Context

      The first case of the new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), was identified in Wuhan, China, in late 2019. Since then, the coronavirus disease 2019 (COVID-19) outbreak was reclassified as a pandemic, and health systems around the world have faced an unprecedented challenge.

      Objective

      To summarize guidelines and recommendations on the urology standard of care during the COVID-19 pandemic.

      Evidence acquisition

      Guidelines and recommendations published between November 2019 and April 17, 2020 were retrieved using MEDLINE, EMBASE, and CINAHL. This was supplemented by searching the web pages of international urology societies. Our inclusion criteria were guidelines, recommendations, or best practice statements by international urology organizations and reference centers about urological care in different phases of the COVID-19 pandemic. Our systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of 366 titles identified, 15 guidelines met our criteria.

      Evidence synthesis

      Of the 15 guidelines, 14 addressed emergency situations and 12 reported on assessment of elective uro-oncology procedures. There was consensus on postponing radical prostatectomy except for high-risk prostate cancer, and delaying treatment for low-grade bladder cancer, small renal masses up to T2, and stage I seminoma. According to nine guidelines that addressed endourology, obstructed or infected kidneys should be decompressed, whereas nonobstructing stones and stent removal should be rescheduled. Five guidelines/recommendations discussed laparoscopic and robotic surgery, while the remaining recommendations focused on outpatient procedures and consultations. All recommendations represented expert opinions, with three specifically endorsed by professional societies. Only the European Association of Urology guidelines provided evidence-based levels of evidence (mostly level 3 evidence).

      Conclusions

      To make informed decisions during the COVID-19 pandemic, there are multiple national and international guidelines and recommendations for urologists to prioritize the provision of care. Differences among the guidelines were minimal.

      Patient summary

      We performed a systematic review of published recommendations on urological practice during the coronavirus disease 2019 (COVID-19) pandemic, which provide guidance on prioritizing the timing for different types of urological care.

      Keywords

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      References

      1. World Health Organization. Coronavirus disease (COVID-2019) situation reports. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/.

      2. Ficarra V., Novara G., Abrate A., et al. Urology practice during COVID-19 pandemic. Minerva Urol Nefrol. In press. https://doi.org/10.23736/S0393-2249.20.03846-1.

      3. USANZ. Guidelines for urological prioritisation during COVID-19. https://www.usanz.org.au/news-updates/our-announcements/usanz-announces-guidelines-urological-prioritisation-covid-19.

      4. Goldman HB, Haber GP. Recommendations for tiered stratification of urologic surgery urgency in the COVID-19 era. J Urol. In press. https://doi.org/10.1097/JU.0000000000001067.

        • Ribal M.J.
        • Cornford P.
        • Briganti A.
        • et al.
        EAU Guidelines Office Rapid Reaction Group: An organization-wide collaborative effort to adapt the EAU guidelines recommendations to the COVID-19 era.
        2020
      5. Kutikov A., Weinberg D.S., Edelman M.J., Horwitz E.M., Uzzo R.G., Fisher R.I. A war on two fronts: cancer care in the time of COVID-19. Ann Intern Med. In press. https://doi.org/10.7326/M20-1133.

        • Carneiro A.
        • Wroclawski M.L.
        • Nahar B.
        • et al.
        Impact of the COVID-19 pandemic on the urologist’s clinical practice in Brazil: a management guideline proposal for low- and middle-income countries during the crisis period.
        Int Braz J Urol. 2020; 46: 501-510
      6. Katz E.G., Stensland K.S., Mandeville J.A., et al. Triaging office-based urology procedures during the COVID-19 pandemic. J Urol. In press. https://doi.org/10.1097/JU.0000000000001034.

        • Metzler I.S.
        • Sorensen M.D.
        • Sweet R.M.
        • Harper J.D.
        Stone care triage during COVID-19 at the University of Washington.
        J Endourol. 2020; 34: 539-540
      7. Mottrie A. ERUS (EAU Robotic Urology Section) guidelines during COVID-19 emergency. https://uroweb.org/wp-content/uploads/ERUS-guidelines-for-COVID-def.pdf.

      8. American College of Surgeons. COVID-19 and surgery. https://www.facs.org/covid-19.

      9. Lei S., Jiang F., Su W., et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. In press. https://doi.org/10.1016/j.eclinm.2020.100331.

        • Stensland K.D.
        • Morgan T.M.
        • Moinzadeh A.
        • et al.
        Considerations in the triage of urologic surgeries during the COVID-19 pandemic.
        Eur Urol. 2020; 77: 663-666
      10. Ahmed K., Hayat S., Dasgupta P. Global challenges to urology practice during COVID-19 pandemic. BJU Int. In press. https://doi.org/10.1111/bju.15082.

        • Lalani A.A.
        • Chi K.N.
        • Heng D.Y.C.
        • et al.
        Prioritizing systemic therapies for genitourinary malignancies: canadian recommendations during the COVID-19 pandemic.
        Can Urol Assoc J. 2020; 14: E154-8
      11. Quaedackers JSLT, Stein R, Bhatt N., et al. Clinical and surgical consequences of the COVID-19 pandemic for patients with pediatric urological problems: statement of the EAU Guidelines Panel for Paediatric Urology, March 30 2020. J Pediatr Urol. In press. https://doi.org/10.1016/j.jpurol.2020.04.007.

      12. Proietti S., Gaboardi F., Giusti G. Endourological stone management in the era of the COVID-19. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.03.042.

        • Gillessen S.
        • Powles T.
        Advice regarding systemic therapy in patients with urological cancers during the COVID-19 pandemic.
        Eur Urol. 2020; 77: 667-668