Where do Urologists Stand in the Era of Novel Coronavirus-2019 Disease

Thomas Hughes; Hui Ching Ho; Shahrokh F. Shariat; Bhaskar Kumar Somani

Disclosures

Curr Opin Urol. 2020;30(4):610-616. 

In This Article

Non-oncological Diseases

Renal Stone Disease

Although a benign condition, many cases of renal stones present a serious threat to health if associated with renal impairment and/or infection Table 1. Cases awaiting surgery should be carefully evaluated to determine their priority. Renal stone treatment may need to be postponed and only ureteric stones treated actively. Preferential cases would be those with a solitary kidney, renal impairment, associated with sepsis or with a ureteric stent in situ for a prolonged period. Ureteric stents can increase the risk of infection and stent encrustations, making their removal challenging. Stent encrustation can be seen in 76.3% of cases when left in situ for more than 12 weeks.[11] In patients where stents have been left in situ for over six months, complications can arise from longer procedural time or the need for multistep invasive procedures.[12]

Alternatives to ureteroscopy or percutaneous nephrolithotomy such as shockwave lithotripsy should be utilized where possible as these can be performed as an outpatient procedure and reduce the need for a general anaesthetic.[13] When stone surgery is performed and ureteric stenting is required, stent-on-strings should be considered to avoid further hospital attendance for removal. Although there is a 10% risk of premature stent dislodgement with string use, this was not associated with adverse outcomes.[14]

Renal Transplant

Decisions regarding renal transplantation can be particularly challenging with many patients dying on the waiting list which is usually long, yet transplantation can lead to increased risk of exposure to COVID-19 and mortality.[15]

Patients with chronic kidney disease are at an increased risk of mortality from COVID-19.[16] Those requiring haemodialysis will still need attend a healthcare setting regularly, which increases the potential exposure to the virus.[17]

Renal transplant patients are on life-long immunosuppression leaving them more susceptible to infectious diseases, which is particularly relevant in the immediate postoperative period when on a high-dose induction regimen.[18] Although at a higher risk of developing severe disease in COVID-19, early recognition and appropriate treatment can improve prognosis.[19]

Some may require intensive or high dependency care postoperatively which may not be possible during the COVID-19 pandemic.[20] In-depth counselling with the patient about the risks is essential. To reduce transmission risk, while addressing the current demand of transplantation, deceased donors should be prioritized but live donors should be delayed.

Other Benign Urological Diseases

Bladder outflow obstruction secondary to benign prostatic enlargement (BPH) can be managed conservatively with a urethral catheter or suprapubic catheter and surgical management deferred until the pandemic has eased. Similarly, surgery for urinary incontinence and andrology or infertility procedures should be suspended to reduce burden on theatres and staffing. Benign scrotal procedures for disease such as epididymal cyst or hydrocoele are usually performed for mild symptoms and can therefore be deferred.[21] Although usually performed as a day-case procedure, prolonged length of stay or readmission may be required from haematoma or infection in the postoperative period.

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