Management NMIBC in COVID19 Era

Dear All,

We are in COVID Era and how long it will be with us is at present Unknown though there are many talks about the curve being flattened but as USI Council justifiably mention that we will be faced with limiting Urological surgeries for a sometime to come. This postponement of not offering the appropriate treatments at the initial visit of the patient could cause progression of disease but this could be more so with Urological Cancers but definitely not less with Non Urological conditions.

We had a two Webinars recently organized by USI where these aspects were discussed at some length (I am not going into details as I believe most of us would have listened to these Webinars).

The discussion that is being provided concerns ‘NMIBC Treatment in COVID19 era’.

They are discussing on management between Low Risk and High Risk NMIBC. How can they arrive at this segregation without proper evaluation including endoscopy and often TURBT? I am not in full agreement with the discussion. I would appreciate if our experts will shed light on what their preferences are in this Pandemic period.

Hoping to have a discussion on this as it is likely that this Pandemic could last longer than we predict and such issues will become of considerable importance

With warm regards,




  • Dr. Anil Takvani
    Dr. Anil Takvani
    19 Apr 2020 12:13:09 PM

    I have a 60 year male patient , has history of coronary bypass before 3 years.

    He has haematuria of 3 to 4 weeks.
    USG/ CT scan showing 2.5* 2.0 cm bladder growth at right lateral wall. Both ureters and kidneys normal.
    I am going to resect this growth tomorrow in my hospital.
    I am going to use PPE for myself, my OT staff and my patient.
    Am I doing right?
    Seeking comments from experts...

  • Venugopal P
    Venugopal P
    20 Apr 2020 09:44:11 AM

    Dear All,

    Anil has posted a real life scenario.

    This applies to Practicing Urologists, mostly solo, with just adequate OT facilities. The various guidelines now proposed lay emphasis on the Issue of ‘Air Cleaning’ in the OT. At many small centres this aspect is not given adequate importance. They have at best an A/C unit and believe that it is sufficient. It has been mentioned that these can have organisms trapped in such A/C units and this has been mentioned regarding COVID19 as well.

    Should we accept doing procedures in such OT’s are is it better to refer such cases needing procedures to centres with adequate facilities. Many of our patients would be reluctant for this as it implies more financial burden.

    Should such procedures be undertaken under GA or can regional anaesthesia (Spinal and such). In one of the guidelines from Anaesthesia recommend GA in preference to Regional. The point highlighted is that coughing and such during the procedure can be minimised with GA. It is said even in the well equipped centres, a minimum time of 15 minutes should elapse after Intubation before the procedure commences. During the time of Intubation and waiting period, others excepting the Anaesthesia team should be present in the OT.

    According some studies now available, all patients needing such procedures should be screened for COVD19 and preferably only patients who are negative can be accepted. For those who test positive in need of Procedures should be undertaken only in designated OT’s of COVID19 Centres. Most Urological Surgeries do not fall in acute Emergency category and hence they can wait till screening results are obtained.  

    Use of PPE is a definite requirement for all procedures undertaken in any OT.

    I would appreciate the views of experts who are talking on this subject.

    IN a case of NMIBC, especially in a country like India, TURBT will have to be undertaken early so that the Risk stratification could be done. The further treatment is based on this. I do not agree with the view that in Low Risk category, one can defer TURBT but how are we going to state a case as low risk if it is not resected.

    With warm regards,


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