Urology during COVID-19 Pandemic Crisis: A Systematic Review
Bikash Bikram Thapa1, Dhan Shrestha2, Sanjeeb Bista1
1Department of Surgery, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal.
Insights
The COVID-19 pandemic necessitates a shift in urology care from patient-based to population-based strategies. Consensus highlights triage-based urology services, prioritizing life-threatening conditions and ethical resource allocation during public health crises.
Area of Science:
- Urology
- Public Health
- Medical Ethics
Background:
- The COVID-19 pandemic presents unprecedented challenges to healthcare systems globally.
- The shift from patient-centered to population-centered care during pandemics raises ethical dilemmas for urologists.
- There is a need to establish consensus on modified urology care protocols applicable during pandemics.
Purpose of the Study:
- To explore consensus on modified standard urology care practices during the COVID-19 pandemic.
- To identify strategies for ethical and quality urology care delivery in a pandemic setting.
- To provide a framework for urology practice during current and future pandemics.
Main Methods:
- Exploratory study design utilizing secondary data analysis.
- Data extraction from a web-based medical library using keywords: COVID-19, SARS-CoV-2, and urology.
- PRISMA protocol employed for data screening, eligibility, and inclusion, summarizing findings into four themes: general care, surgical modality, triage, and training.
Main Results:
- Analysis of 63 academic papers, predominantly expert opinions and perspectives.
- Strong consensus on triage-based urology care and surgeries, prioritizing life or organ-threatening conditions.
- Emphasis on universal protective measures, protocol-based care, resource conservation, and informed decision-making for ethical population-based healthcare.
Conclusions:
- The COVID-19 pandemic is transforming standard urology practice into crisis-standard, population-based care.
- Consensus during crises is derived from evolving medical evidence and public health ethics.
- Urology care provision during pandemics depends on resource availability, disease severity, service deferral consequences, and pandemic dynamics.
Abstract:
Background Coronavirus disease 2019 (COVID-19) has evolved as a pandemic of unimaginable magnitude. The health care system is facing a tremendous challenge to provide ethical and quality care. The transformation of the patient-based care to population-based care during the COVID-19 pandemic has raised ethical dilemma among urologists. Our objective is to explore the consensus in modified standard urology care, that can be adopted and applied during COVID-19 and similar pandemic. Methods We adopted an exploratory study design using secondary data. The data were extracted from a web-based medical library using keywords "COVID-19," "severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)," and "urology." We identify and extrapolate (screening, eligibility, and inclusion) the data using PRISMA protocol, and summarize pandemic standard urology care under four main themes: (1) general urology care, (2) choice of surgical modality, (3) triage, and (4) urology training. Result We identified 63 academic papers related to our research question. The majority are expert opinions and perspectives on urology care. The common consensus is triage-based urology care and surgeries. Life or organ threatening conditions need immediate attention. Universal protective measures (personal protective equipment, safe operative environment) and protocol-based patient care are necessary to prevent and control SARS-CoV-2 infection. Conservation of the resources and its rational distribution provide an ethical basis for population-based health care during a pandemic. Informed decision making serves best to patients, families, and society during the public health crisis. Conclusion COVID-19 pandemic tends to transform standard urology practice into crisis standard population-based care. The consensus in crisis is drawn from evolving pieces of medical evidence and public health ethics. The provision of urology care during a pandemic is based on the availability of resources; severity of the disease, consequences of deferment of service, and dynamics of the pandemic.
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