Extensive impact of COVID-19 pandemic on pelvic floor dysfunctions care: A nationwide interdisciplinary survey

Abstract

Aims: To investigate the impact of COVID-19 pandemic on health-care provision to patients suffering from pelvic floor dysfunctions in Italy.

Methods: A retrospective web-based interdisciplinary survey was mailed by the Italian Society of Urodynamics to members involved in pelvic floor dysfunctions management from June 22, 2020 to July 17, 2020. The 84-item questionnaire investigated the period March-June 2020 (first epidemic wave) and showed high content validity. The primary outcome was the mean rate of cancellation for health-care services. Secondary outcomes included estimation of the accumulated surgeries backload until return to baseline activity and of the recovery pattern, using linear regression and scenario-based forecasting.

Results: A total of 85 participants provided complete responses. Respondents were mostly urologists (47%), followed by gynecologists (29.5%) and physiatrists (17.6%). On average, 78.4% of outpatient services and 82.7% of functional surgeries were canceled, without significant differences by geographical distribution. An impact on patients' quality of life was anticipated by most of the respondents (87%) and 48.2% also reported potentially serious health risks for patients. Thirty-three percent of the respondents reported the use of telemedicine. If the nation-wide surgical activity increases by 20% postpandemic, it would take 37 months to clear the backlog of functional surgeries. We acknowledge the inherent limitations of the survey methodology and retrospective design.

Conclusions: Access to care for patients suffering from pelvic floor dysfunctions has been dramatically affected by the COVID-19 outbreak. The indirect effects of this unprecedented disruption on pelvic floor dysfunctions care may last for several months.

Keywords: COVID-19 pandemic; benign prostatic hyperplasia; chronic pelvic pain; cystitis; incontinence; overactive bladder; pelvic floor dysfunction; pelvic organ prolapse; perineal fistula.

Figure 1

Mean cancellation rates (with standard deviations) for outpatient consultations, investigations, and procedures

Figure 2

Mean cancellation rates (with standard deviations) for functional surgeries

Figure 3

Heat maps showing mean cancellation rates by region over the period covered by the survey (March–April 2020) for outpatient health‐care services (A) and functional surgery procedures (B)

Figure 4

Estimated functional surgery backload (with 95% confidence intervals) and projected recovery patterns based on three hypothetical scenarios (10%, 20%, and 30% increases in baseline surgical volume). The incidence of COVID‐19 in Italy during the period covered by the survey is also shown. COVID‐19, Coronavirus Disease 2019