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. 2020 Sep 15;15(9):e0239027.
doi: 10.1371/journal.pone.0239027. eCollection 2020.

To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic

Nina N Harke  1 , Jan P Radtke  2 , Boris A Hadaschik  2 , Christian Bach  3 , Frank P Berger  4 , Andreas Blana  5 , Hendrik Borgmann  6 , Florian A Distler  7 , Sebastian Edeling  8 , Tobias Egner  9 , Christina L Engels  10 , Mahmoud Farzat  11 , Alexander Haese  12 , Rainer Hein  13 , Markus A Kuczyk  1 , Andreas Manseck  14 , Rudolf Moritz  15 , Michael Musch  16 , Inga Peters  1 , Sasa Pokupic  17 , Bernardo Rocco  18 , Andreas Schneider  19 , André Schumann  20 , Christian Schwentner  21 , Chiara M Sighinolfi  18 , Stephan Buse  22 , Jens-Uwe Stolzenburg  23 , Michael C Truß  24 , Michael Waldner  25 , Christian Wülfing  26 , Volker Zimmermanns  27 , Jörn H Witt  28 , Christian Wagner  28
Affiliations

To defer or not to defer? A German longitudinal multicentric assessment of clinical practice in urology during the COVID-19 pandemic

Nina N Harke et al. PLoS One. .

Abstract

Introduction: After the outbreak of COVID-19 unprecedented changes in the healthcare systems worldwide were necessary resulting in a reduction of urological capacities with postponements of consultations and surgeries.

Material and methods: An email was sent to 66 urological hospitals with focus on robotic surgery (RS) including a link to a questionnaire (e.g. bed/staff capacity, surgical caseload, protection measures during RS) that covered three time points: a representative baseline week prior to COVID-19, the week of March 16th-22nd and April 20th-26th 2020. The results were evaluated using descriptive analyses.

Results: 27 out of 66 questionnaires were analyzed (response rate: 41%). We found a decrease of 11% in hospital beds and 25% in OR capacity with equal reductions for endourological, open and robotic procedures. Primary surgical treatment of urolithiasis and benign prostate syndrome (BPS) but also of testicular and penile cancer dropped by at least 50% while the decrease of surgeries for prostate, renal and urothelial cancer (TUR-B and cystectomies) ranged from 15 to 37%. The use of personal protection equipment (PPE), screening of staff and patients and protection during RS was unevenly distributed in the different centers-however, the number of COVID-19 patients and urologists did not reach double digits.

Conclusion: The German urological landscape has changed since the outbreak of COVID-19 with a significant shift of high priority surgeries but also continuation of elective surgical treatments. While screening and staff protection is employed heterogeneously, the number of infected German urologists stays low.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Changes in capacities.
Trends in 27 urological departments (percentage change of total numbers (left y-axis, orange bars) and median number/center (right y-axis, blue line) for available beds (a), staff members (b) summed up operating rooms/week (c). D shows the portion of reductions in OR capacities in the different centers (y-axis).
Fig 2
Fig 2. Changes in scheduled cases.
Percentage change of total numbers (left y-axis, orange bars) and median number/center (right y-axis, blue line) for scheduled cases subdivided into oncological procedures (a), stone therapy (b), surgical treatment of benign prostate syndrome (c) and other surgeries (d).
Fig 3
Fig 3. Changes in oncological surgeries.
Percentage change of surgical therapy of prostate cancer after stratification according to the D’Amico score (a), renal masses with clinical stages (b), subgroups of procedures for urothelial cancer (c) and penile and testicular cancer (d).
Fig 4
Fig 4. Protection during robotic surgery.
Implementation of protection measures (in %) during robot-assisted surgeries in the different participating German centers.
See this image and copyright information in PMC

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