Implications to Clinical Practice
The significant increase in demand on critical care facilities in health systems throughout the world has had extensive implications on the urological service provision.[7–9] The number of patients requiring intubation and ventilation to manage respiratory failure from COVID-19 has resulted in the redeployment of anaesthetists to ICUs. In many cases, ventilators and theatres are being repurposed to ICUs as existing facilities are overburdened by the number of cases requiring admission. Furthermore, the number of acutely unwell patients requiring admission to the hospital has meant that wards have been allocated for the care of those with COVID-19, reducing availability of bed space for non-COVID-19 patients. Medical staff are at particular risk of developing COVID-19 from increased exposure to the virus, especially in areas where there is reduced availability of adequate PPE. This can result in staff shortages throughout hospitals, necessitating redeployment to areas most in need such as ICU and the emergency department. Many organizations and governments have ordered a suspension of elective surgeries as a consequence of this. The impact on individual centres will vary in intensity and timing; however, the urologist should be prepared to work outside of their usual range of practice in the depths of the crisis.
As a speciality, urology provides a variety of services to the local population. This ranges from lower priority surgical procedures including circumcision and vasectomy to emergency procedures for testicular torsion or infected obstructed kidneys. Urology services must focus on continuing to provide an emergency service, while postponing lower priority procedures to allow capacity for COVID-19 cases. The challenge for urology departments is managing cases that lie somewhere between these two categories including those with malignancy or awaiting renal transplantation for end-stage renal failure.
Curr Opin Urol. 2020;30(4):610-616. © 2020 Wolters Kluwer Health, Inc.