Discussion
Although COVID-19 seems to have a distant relationship with urinary diseases, most of urological patients are elderly individuals with relatively lower immunity and multiple underlying diseases. This makes them highly susceptible to SARS-CoV-2, and severe cases of it at that. In addition, COVID-19 is likely to cause renal failure once urinary obstruction occurs, and failure to promptly protect against or treat this condition could be life-threatening.[3] Our data showed an increased incidence of tube-related emergencies compared to other emergent problems during the COVID-19 period. In addition, the higher secondary complex operation rate suggests the increased complications associated with tube-related emergent operations during the pandemic, a finding which is in accordance with a recent report.[4] These situations may be attributed to the delayed replacement of tubes, less social activity, the postponement of treatment due to a fear of infection as well as the inconvenience of traveling to the hospital, and interference with operational accuracy caused by protective equipment. Therefore, these patients merit attention.
The optimized strategies give priority to operation success rates and the avoidance of multiple operations. Many optimized procedures, such as the direct replacement of obstructed tubes instead of simple rinses, the thoroughly flushing out of clots or sediment, and the checking of patency after operation, ensured operational effectiveness and lower readmission rates within a short period of time postoperatively. This in turn reduce the exposure risk for both doctors and patients. It is important to note that when doctors followed the optimized operation principles and strategies, the mean surgery time during the COVID-19 period was comparable to that of the control period, although the doctors' vision and movement were greatly impacted by the protective equipment and the operational complexity was elevated. The optimized strategies compensated for surgery time by promoting adequate evaluation and preparation, the selection of simple and reliable operations, and reduced attempts to use methods with low success rates. These data demonstrated that the optimized strategies can guarantee the success rate and efficiency of urological tube-related emergent operations.
SARS-CoV-2 is known to be transmitted through the respiratory tract, close contact, and aerosolized particles.[5,6] Recently it has been isolated from the urine of COVID-19 patients, suggesting that contact with patients' urine may also become a potential route of infection.[7] Some studies have shown that 30–60% of the SARS-CoV-2-infected population may be asymptomatic and tested negatively during the early phase of infection; however, these individuals may still be capable of infecting others.[7–11] Operational urologists are exposed to a high infection risk by coming into contact with patients' breath/blood/urine while performing urological tube-related procedures. Therefore, the optimized strategies suggest standard second-level protection when entering the contaminated areas and making contact with patients during the pandemic. Performing simple and low-exposure operations, controlling surgery time, and decreasing the need for multiple operations also help to prevent surgeons and patients from becoming infected with SARS-CoV-2. The lack of COVID-19 infections among all participants in this study indicate the safety of the optimized strategies.
Some limitations existed in this study. First, in order to decrease the exposure risk of all of our participants, we did not set control group with patients under routine management during COVID-19 period. This prevented us from making additional comparisons. Second, the study focused on a single hospital and used a relatively small sample size and short follow-up period. Third, the cost effectiveness property of the optimized strategies was not evaluated.
Transl Androl Urol. 2021;10(1):466-474. © 2021 AME Publishing Company
