Urological Practice during COVID19 Pandemic

• 27 Mar 2020 05:53:56 PM
• |Uroacademy Bulletins

Dear All,

Italy, as we know, is a country with high incidence of COVID19 with high ratio of Mortality. It has literally brought the country to a standstill. But for the sake of preventing and treating this pandemic, it should be realised that many diseases that afflict mankind can continue to exist and some demanding urgent attention. In this Urological Diseases are not exempt. Diseases that we commonly see still occur needing on many occasions hospitalisation and decision on further treatments. Many patients could be midway of treatment and neither here or there. Many Urological Emergencies can crop up during this period. Hospital Beds are going to be scarce (already so in many countries) where even accepting these patients for treatments are going to be difficult. We are concerned about patients with Urological disorders but what about other specialties where delay for treatments could be catastrophic. Majority of our illnesses, baring few are not life threatening and hence alternate ways of treatments will have to be considered.

Prof. Vincenzo Ficarra and Members of the Research Urology Network deliberated on the issues concerning Urological diseases and what would be the optimal way for tackling these disorders in these trying times. They have prioritized the various diseases and have suggested what could be done for them till this pandemic is overcome. But for how long is a question that no one seems to have an answer now. They conclude by stating that this document presented could be useful tool for consideration by many Urological societies but then it should be realized that such decisions can be based only on what is happening in each country.

This article is copyrighted and please do not circulate it. This is being provided as we are a private group.

With warm regards,

Venu

Comments(3)

• 

  Venugopal P

  27 Mar 2020 05:55:50 PM

  Please Scroll till the very end even after References for tables

  Venu

• 

  Venugopal P

  01 Apr 2020 07:53:58 AM

  Dear All,

  I had provided an article by the Italian Group of Urologists on ‘Urological Practice during COVID19 Pandemic’ few days ago. Now I am providing a rapid guideline development manuscript prepared on behalf of European Urology and released on March 15^th, 2020.

  It's not possible to create a cookbook in the face of a rapidly evolving pandemic. For eg, what should be done with a newly diagnosed P Ca. Some have suggested ADT (though not the recommended standard) and defer RP, RT etc for a later date. Will this be acceptable for the majority of practicing Urologists?

  Ashish Kamat conducted a survey as regards treatment for Stage T2 high grade MIBC with normal GFR in this era of COVID19. 44% responded by Stating Neoadjuvant Chemo for the present and defer Radical cystectomy, while 41% preferred Radical Cystectomy with ERAS protocol. ~12% suggested TMT.

  As we know that deferring RC’s in such a scenario will change the outcome of treatment. but with pandemic spreading like a wild fire, are RCs Indicated for the present.

  I am providing the link for the manuscript as has been made available.

  https://els-jbs-prod-cdn.literatumonline.com/pb/assets/raw/Health%20Advance/journals/eururo/EURUROL-D-20-00380-1584548684213.pdf

  I would like to know from our group as to their policy in accepting surgeries during this pandemic. Do we refrain from performing Urological Procedures, treating them conservatively or do we accept patients for Surgeries as required with minimal considerations for the Pandemic. All these Opinions should be country specific as a standard cookbook cannot be made in such a time.

  Your views will help most of the members.

  With warm regards,

  Venu

   

• 

  Venugopal P

  04 Jun 2020 08:13:34 AM

  Dear All,

  I had provided an article by the Italian Group of Urologists on ‘Urological Practice during COVID19 Pandemic’ and also the rapid guideline development manuscript prepared on behalf of European Urology. In my previous write ups, I had mentioned that in this present scenario, the needed guidelines to follow should be country specific (this is true even at other times) and have come out with the recommendations to be followed under Indian Scenario.

  In this recommendation, you will notice very little changes from the previous two materials provided. But the authors have put most facts in a clear perspective. The tables provided can give us the options to be followed at a glance and is welcome for all busy Urologists.

  http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2020;volume=57;issue=2;spage=129;epage=138;aulast=Narain (PDF available)

  http://www.indianjcancer.com/temp/IndianJournalofCancer572129-5782151_013622.pdf

  I would like to place another article that could assume importance is on ‘ADT therapies for P Ca and risk of SARS-CoV-2’. This hypothesis mentions that ADTs may protect patients affected by COVID19.

  Comparing the total number of COVID19 positive cases, Prostate Cancer patients receiving ADT had a significantly lower risk of SARS-CoV-2 infection compared to patients who did not receive ADT. In the recommendations provided, it is said that patients with P Ca could be offered ADTs but the reason why could be understood by this article.

  https://www.annalsofoncology.org/article/S0923-7534(20)39797-0/pdf

  TMPRSS2 is an androgen-regulated gene implicated in the pathogenesis of prostate cancer. This gene is also involved in the lung effects of COVID-19). Men have been more severely affected by COVID-19 and speculation has surrounded higher levels of TMPRSS2 and higher androgen levels as a culprit. But the number of cases indicates that it is low to come to any definitive conclusion.

  But there are other studies ongoing as well. The Veterans Administration is studying Degarelix vs placebo in men admitted with COVID-19. Oestrogen therapy and oral bicalutamide vs placebo are also being studied. And Tom Beer and colleagues at OHSU are planning to test enzalutamide vs placebo in a pilot trial. This is based on the potential to down regulate TMPRSS2 in lung epithelium, but the actual science/data on this is very mixed and fairly negative. Most feel this is definitely worth trying in an era where very little can be offered to these patients with COVID19. If any of the ADT-COVID clinical trials spurred on by the data from Montopoli et al pan out, our use of ADT in the midst of the COVID pandemic may have been a good move for an unexpected reason!

  With warm regards,

  Venu