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Objective: COVID-19 pandemic represents a dramatic challenge for healthcare systems worldwide, and it also affects daily urological practice. After China and Italy, Tessin (Switzerland) has been hit the hardest, due to its close proximity to Lombardy and the high number of frontier workers in the area. Our objective was to share with the scientific community how, during the COVID-19 period, there has been a huge modification in urological emergencies throughout all hospitals included in the Ente Ospedaliero Cantonale (EOC). Methods: We retrospectively reviewed urgent urological consultations requested by the emergency department (ED) of the 4 public hospitals located in Tessin belonging to EOC in the 3-month period between February 15 and May 15, 2020, and compared them to the 2 previous years cases within the same time frame (February 15 to May 15, 2018 and 2019). The number of daily consultations, urgent invasive procedures performed, and admissions were evaluated. Results: The final sample resulted in 594 consultations performed in 2020, 974 in 2018, and 974 in 2019. A higher number of daily consultations were performed during 2018 and 2019. The number of daily admissions dropped consistently during the COVID-19 pandemic (737 vs. 392). Conclusions: Our multicenter study aimed to quantify changes in urgent urological care in Tessin in the midst of the COVID-19 pandemic. Urgent urology practice was dramatically affected with a remarkable reduction in urgent urological consultations, whereas a higher risk of admissions was observed in 2020, due to the severity of the patients.

Background and Objective: Recently, the Advanced Chronic Kidney Disease Units (UERCA) have been developed in Spain to offer a better quality of life to patients with ACKD, improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (S.E.N.), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. Material and Methods: An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16, 2018, until September 26, 2018. Results: A total of 95 (78,5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54,4%) mandatory and 31 of them (45,5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25–29 ml/min/ 1.73 m2 of glomerular filtration. Conclusions: This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCAs, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units. Resumen: Antecedentes y Objetivo: Recientemente, se han desarrollado en España las Unidades de Enfermedad Renal Crónica Avanzada (UERCA) con el objetivo de ofrecer una mayor calidad de vida a los pacientes con ERCA, mejorar su supervivencia y disminuir la morbilidad en esta fase de la enfermedad. A día de hoy, hay poca evidencia en la literatura española e internacional con respecto a la estructura y cómo conseguir estos objetivos en las Unidades ERCA. Desde el grupo de trabajo ERCA de la Sociedad Española de Nefrología (S.E.N.), se impulsa este proyecto para mejorar la atención a los pacientes ERCA a través de la definición de estándares de calidad para el funcionamiento de las UERCA. Material y Métodos: Se conformó una propuesta inicial de estándares de calidad sobre el funcionamiento de las UERCA a través de la consulta de principales fuentes de referencias y el asesoramiento de un grupo de trabajo de expertos a través de reuniones presenciales y no presenciales. A partir de esta propuesta inicial de estándares, se diseñó y envío una encuesta vía correo electrónico a 121 especialistas de nefrología y profesionales de enfermería con experiencia en UERCA españolas para conocer entre otros, la idoneidad de cada estándar, es decir, su obligatoriedad o recomendación como estándar. Se permitió acceso a la encuesta entre el 16 de julio de 2018, hasta el 26 de septiembre de 2018. Resultados: Participaron un total de 95 (78,5%) profesionales de los 121 que fueron invitados a participar. De éstos, 80 de los participantes fueron especialistas en nefrología y 15 profesionales de enfermería, obteniéndose una variada representación de profesionales de la geografía española. Tras analizar las opiniones de estos participantes, los estándares quedaron definidos a un total de 68, 37 de ellos (54,4%) obligatorios y 31 de ellos (45,5%) recomendables. Además, se observó que el volumen de pacientes atendidos en las UERCA se sitúa usualmente por encima de los 100 pacientes, y que el criterio de derivación por regla general está por debajo de 25−29 ml/min/1,73 m2 de filtración glomerular. Conclusiones: Este trabajo constituye una primera propuesta de estándares de calidad para el funcionamiento de una UERCA en España. La definición de estos estándares ha permitido establecer las bases para la estandarización de la organización de las UERCA, y trabajar posteriormente en la configuración de un manual de estándares para la acreditación de Unidades ERCA.

Purpose Urological service provision has changed dramatically with the advent of the SARS-CoV-2, necessitating restructuring and reorganization. The aim of this study was to review the reorganization of our unit, map the change in volume of departmental activities and discuss potential solutions. Methods Departmental activities over the months of April and May 2020 and 2019 were analysed. Details of admissions, operations, diagnostic procedures, outpatient reviews, morbidities and mortalities were recorded. Operations were performed on two sites, with elective operation transferred to an offsite, COVID-free hospital. Results Seventy-four emergency operations were performed onsite, with 85 elective operations outsourced. A total of 159 operations were performed, compared with 280 in the same period in 2019. Five (5.0%) of 101 admitted patients to the COVID hospital contracted COVID-19. No patients outsourced to the COVID-free hospital were infected there. Outpatient referrals to urology service decreased from 928 to 481. There was a 66% decrease in new cancer diagnoses. A virtual review clinic was established, with remaining outpatients reviewed through a telephone clinic platform. Conclusion Compared with 2019, we performed fewer operations and outpatient procedures, had fewer admissions and diagnosed fewer patients with new cancers. However, outsourcing elective operation to designated non-COVID hospitals prevented the infection of any patient with COVID-19 in the post-operative period. The use of virtual clinic and telephone clinic has had some success in replacing traditional outpatient visits. The overall significant decrease in operative volume will likely precipitate a mismatch between demand and service provision in the coming months, unless capacity is increased.

Considering the new coronavirus epidemic (Covid-19), the Brazilian Society of Nephrology, represented by the Peritoneal Steering Committee, in agreement with the and the Dialysis Department, developed a series of recommendations for good clinical practices for peritoneal dialysis (PD) clinics, to be considered during the period of the Covid-19 epidemic. We aim to minimize the disease spread, protecting patients and staff, and ensuring the quality of the treatment provided and adequate follow-up for PD patients. The recommendations suggested at this moment must be adapted to each clinic’s reality and the conditions of the structural and human resources, dependent on the adequate financial provision of the public health system for its full implementation.

Background and aims Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures. Methods and results A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures. Conclusions Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.

Dialysis units are environments potentially prone to the spread of Covid-19. Patients cannot suspend treatment, and they often have comorbidities, which assigns them a higher risk and worse prognosis. The Brazilian Society of Nephrology prepared this document of good practices, whose technical recommendations deal with general measures that can be implemented to reduce the risk of transmission and prevent the spread of the disease in the unit.

Objective To evaluate the coronavirus disease 2019 perioperative infection rate and mortality rate of patients undergoing urological surgeries during the early pandemic period in Spain. Methods This was a non-interventional multicenter prospective study carried out from 9 March to 3 May 2020 in two urology departments in Madrid, Spain. Clinical, microbiological and radiological data of patients who underwent surgery were collected from computerized medical records. Results A total of 148 patients were included in the study, and 141 were analyzed for nosocomial infection risk, after excluding previous and concomitant severe acute respiratory syndrome coronavirus type 2 infections. Elective surgeries represented 76.6% of the procedures, whereas emergent surgeries represented 23.4%. Preoperative screening was carried out with polymerase chain reaction test in 34 patients, all were negative. A total of 14 patients also had chest X-ray (not suspicious in all cases). Three patients (2.1%) developed severe acute respiratory syndrome coronavirus type 2 nosocomial infection (symptoms developed between the third day after surgery to the 14th day after hospital discharge). Time from admission to a compatible clinical case was 5.5 days (4-12 days). Two patients underwent surgery with concomitant diagnosis of coronavirus disease. The mortality rate due to severe acute respiratory syndrome coronavirus type 2 infection is 0.7%, and the specific mortality rate in patients undergoing surgery with community-acquired coronavirus disease 2019 infection was 50% (1/2). Conclusions The nosocomial severe acute respiratory syndrome coronavirus type 2 infection rate was low in patients undergoing urological surgical procedures during the peak of the pandemic in Madrid. With appropriate perioperative screening, urological surgical activity can be carried out in safety conditions.

International audience; Purpose: Lockdown during the COVID-19 pandemic compelled urologists to change access to healthcare, especially for oncology patients. Teleconsultation is a safe way to receive medical advice without a risk of infection, and was implemented urgently in our academic centres. Our purpose was to evaluate patient and physician satisfaction with teleconsultation set up during the COVID-19 pandemic.Methods: From March 16th 2020, all face-to-face consultations were cancelled in France, except for emergencies. Teleconsultation was started immediately by five senior urologists in two academic hospitals. All patients received an email survey including the validated Teleconsultation Satisfaction Questionnaire (TSQ) and demographic questions. Data were collected prospectively. Physicians also responded to the TSQ. Patient satisfaction was measured objectively with the validated 14-item TSQ. Each item was scored on a 5-point Likert scale. Factors associated with positive satisfaction with teleconsultation were assessed by multivariable logistic regression.Results: Overall, 105 patients replied to the survey (91.3%). Median age was 66 years (IQR: 55‒71) and 95 were men (90.5%). Median overall TSQ score was 67 (IQR: 60‒69); teleconsultation was judged to be a good experience by 88 patients (83.8%) and four physicians (80%). Patients who met their surgeon for the first time were more likely to have a good experience (OR = 1.2 [95% CI 1.1‒1.5], p = 0.03).Conclusion: Introduced rapidly during the COVID-19 lockdown, urology teleconsultation attained a high level of satisfaction among both patients and physicians. A major change in telemedicine use is foreseen in the post COVID-19 era.

These recommendations were created after the publication of informative note 3/2020- CGGAP/DESF/SAPS/MS, of April 4, 2020, in which the Brazilian Ministry of Health recommended the use of a cloth mask by the population, in public places. Taking into account the necessary prioritization of the provision of Personal Protective Equipment (PPE) for patients with suspected or confirmed disease, as well as for healthcare professionals, the SBN is favorable concerning the wear of cloth masks by chronic kidney patients in dialysis, in public settings, except in the dialysis setting. The present recommendations have eleven items, related to this rationale, the procedures, indications, contraindications, as well as appropriate fabrics for the mask, and hygiene care to be adopted. These recommendations may change, at any time, in the light of new evidence.

Resumen Introduccion La pandemia por SARS-CoV-2 ha cambiado la practica urologica a nivel mundial. Nuestro objetivo es describir los resultados en salud observados en los pacientes intervenidos en el Servicio de Urologia de un hospital terciario, a lo largo de diferentes fases epidemiologicas. Metodos Estudio de cohortes observacional que incluye todos los pacientes intervenidos entre el 1 de marzo y el 14 de mayo. Segun la organizacion hospitalaria, distinguimos 3 periodos: durante las primeras 2 semanas no hubo cambios (1.er periodo), en las 7 semanas siguientes solo se realizaron intervenciones urgentes previa extraccion de exudado nasofaringeo (2.o periodo), y tras el 4 de mayo se reanudo la cirugia electiva aplicando un protocolo de cribado multidisciplinar (3.er periodo). Las variables demograficas y basales, las quirurgicas y perioperatorias, asi como los resultados postoperatorios, se obtuvieron de forma retrospectiva (periodos 1 y 2) y prospectiva (periodo 3). El seguimiento telefonico se realizo al menos 3 semanas tras el alta hospitalaria. Resultados Se realizaron 103 cirugias urologicas y fueron diagnosticados de COVID-19 11 pacientes, 8 de ellos en el 1.er periodo. El diagnostico era conocido en un paciente, mientras que los otros 10 desarrollaron la enfermedad en una media de 25 dias tras la intervencion y 16,6 dias tras el alta. Cuatro de 7 pacientes trasplantados resultaron afectados. Se registraron 3 muertes por la enfermedad: una mujer de 69 anos trasplantada y 2 varones mayores de 80 anos con comorbilidades y alto riesgo anestesico a los que se realizo drenaje de absceso retroperitoneal y cirugia retrograda intrarrenal, respectivamente. Conclusiones La infeccion por SARS-CoV-2 afecto principalmente a trasplantados renales o pacientes anosos con alto riesgo anestesico, durante las 2 primeras semanas de la pandemia. Tras implantar la PCR preoperatoria y un protocolo completo de cribado, los casos se redujeron de manera sustancial y se pudo operar con seguridad.

Resumen Introduccion y objetivo La coronavirus disease 2019 (COVID-19) ha ocasionado una pandemia de repercusion mundial que obligo a tomar medidas sociopoliticas, como la declaracion del estado de alarma en Espana. Paralelamente se llevo a cabo la reestructuracion de las actividades e infraestructuras medico-quirurgicas pediatricas, con la consecuente suspension de la actividad quirurgica no urgente de Urologia Pediatrica. Analizamos la repercusion de la pandemia COVID-19 sobre la actividad quirurgica en una seccion de Urologia Pediatrica, asi como las complicaciones quirurgicas, segun la clasificacion de Clavien-Dindo. Materiales y metodos Se procedio a la revision sistematica de los datos epidemiologicos, clinicos y quirurgicos, incluyendo las complicaciones y reingresos de todos los pacientes intervenidos en la seccion de Urologia Pediatrica desde la declaracion del estado de alarma hasta el levantamiento del mismo. Para su estudio se procedio a la division en cinco bloques temporales acorde a las fases de desescalada. Resultados Se realizaron 49 intervenciones quirurgicas en 45 pacientes (ocho previos a la implantacion de las fases de desescalada). La patologia con prioridad alta fue la mas frecuente en las primeras fases, siendo la estenosis de la union pieloureteral (EPU) la mas prevalente. Se registraron cuatro complicaciones (8,8%), ninguna de ellas de origen respiratorio. Conclusiones Las recomendaciones de la EAU para la reanudacion de la actividad quirurgica han permitido una correcta, segura y gradual transicion al ritmo quirurgico habitual en Urologia Pediatrica. La clasificacion de Clavien-Dindo es util y valida para su aplicacion en esta seccion. No se han registrados complicaciones respiratorias que pudiesen ser atribuibles a la situacion pandemica.

Objective To provide guidance when performing bedside urologic procedures on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive patients and offer considerations to maximize the safety of the patients and providers, conserve supplies, and provide optimal management of urologic issues. Methods Urologic trainees and attending physicians at our institution, who are familiar with existing safety recommendations and guidelines regarding the care of infected patients, were queried regarding their experiences to determine an expert consensus on best practices for bedside procedures for SARS-CoV-2 positive patients. Results Our team developed the following general recommendations for urologic interventions on SARS-CoV-2 positive patients: maximize use of telehealth (even for inpatient consults), minimize in-room time, use personal protective equipment appropriately, enlist a colleague to assist, and acquire all supplies that may be needed and maintain them outside the room. Detailed recommendations were also developed for difficult urethral catheterization, bedside cystoscopy, incision and drainage of abscesses, and gross hematuria/clot irrigations. Conclusion As patients hospitalized with SARS-CoV-2 infection are predominantly men over 50 years old, there are significant urologic challenges common in this population that have emerged with this pandemic. While there is tremendous variation in how different regions have been affected, the demographics of SARS-CoV-2 mean that urologists will continue to have a unique role in helping to manage these patients. Here, we summarize recommendations for bedside urologic interventions specific to SARS-CoV-2 positive patients based on experiences from a large metropolitan hospital system. Regulations and requirements may differ on an institutional basis, so these guidelines are intended to augment specific local protocols.

The province of Bergamo in Italy and in particular Papa Giovanni XXIII Hospital was one of the first areas to be hit by the SARS-CoV-2 outbreak and experience firsthand all the different phases of the crisis. We describe the timeline of the changes in overall urological workload during the outbreak period from lockdown to the slow reopening of activities. We sought to compare the 2020 hospital scenario with normality in the same period in 2019, highlighting the rationale behind decision-making when guidelines were not yet available. While we focus on the changes in surgical volumes for both elective (oncological and noncancer) and urgent cases, we have still to confront the risk of untreated and underdiagnosed patients. Patient summary We present a snapshot of changes in urology during the peak of the COVID-19 outbreak in our hospital in Bergamo, Italy. The effect of medical lockdown on outcomes for untreated or underdiagnosed patients is still unknown., Take Home Message A noteworthy reduction in routine clinical and surgical urology practice has been experienced during the SARS-CoV-2 outbreak. The effect of medical lockdown on outcomes for untreated or underdiagnosed patients is still unknown.

Purpose COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. Methods we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age

Take Home Message The COVID-19 pandemic has changed the world. Urology needs to overcome these challenges. Our duty is to provide care under any circumstances and our privilege is to re-examine and advance our field. The use of novel communication and health technologies will ensure safety while maintaining high-quality care.

The sudden and unanticipated coronavirus disease 2019 (COVID-19) viral pandemic of 2020 and its profound impact on the NHS prompted an almost overnight change in the services we are able to offer our patients to fulfil clinical demands. From March 2020, we have changed outpatient appointments from face-to-face to telephone-led consultations. We have performed an early review of this service to ensure its sustainability during the unknown duration of this current crisis and to establish its potential utility when normal services resume in the future. Our present results show a patient satisfaction of 93%, with 83% happy to have telephone follow-up in the future, and a clinician satisfaction of 82% in the adequacy of the telephone consultation for making a clinical decision. Telephone clinics are a safe and efficient alternative to face-to-face outpatient consultations for many patients, particularly non-complex benign follow-ups.

The COVID-19 pandemic caused by the SARS-CoV-2 virus has caused tens of thousands of deaths in Spain and has managed to breakdown the healthcare system hospitals in the Community of Madrid, largely due to its tendency to cause severe pneumonia, requiring ventilatory support. This fact has caused our center to collapse, with 130% of its beds occupied by COVID-19 patients, thus causing the absolute cessation of activity of the urology service, the practical disappearance of resident training programs, and the incorporation of a good part of the urology staff into the group of medical personnel attending these patients. In order to recover from this extraordinary level of suspended activity, we will be obliged to prioritize pathologies based on purely clinical criteria, for which tables including the relevance of each pathology within each area of urology are being proposed. Technology tools such as online training courses or surgical simulators may be convenient for the necessary reestablishment of resident education.

The Covid-19 pandemic brought several challenges to the healthcare system: diagnosis, treatment and measures to prevent the spread of the disease. With the greater availability and variety of diagnostic tests, it is essential to properly interpret them. This paper intends to help dialysis units concerning the use of clinical criteria and diagnostic tests for decision making regarding the discontinuation of isolation of patients with suspected or confirmed Covid-19, as well as the return to work activities for employees with suspected or confirmed Covid-19.

Hospitals are dealing with patients who may have clinical discharge but cannot return to their home due to non-medical issues.Cross-sectional analysis of all the cases referred to the Integrated Care Network during the year 2016. Evaluation of waiting times, typology, reason for referral and clinical parameters. IBM SPSS 24.0 software was used for all statisticalanalyses.In the evaluated period, 2294 patients were discharged from our department. Of these, 55 were referred to Integrated Care Network. The mean length of hospitalization of the patients referred to the network was 20.6 ± 11.4 days, and the mean overall length of hospital stay in the period analyzed was 4.8 ± 0.9 days. The mean time between hospitalization and referral for continuing care was 10.7 ± 7.2 days. The time between referral and discharge of the hospital was 10.0 ± 8.7 days. Thirty-nine (70.9%) patients were hospitalized for oncological diseases. The most common referral was to Palliative Care units (n = 16; 29.1%). Patients referred to Palliative Care units showed the largest waiting times between the referral for the network and the hospital discharge, 12.2 ± 10.51 days. We observed 289 hospitalization days with patients who had no need of specialized urological care.In order to reduce time between referral to the network and hospital discharge, there is a need for enhanced cooperation and coordination among doctors, nurses and social workers.Early identification by physicians and nurses of patients who will require care after discharge will provide a better response from social workers and increased hospital performance.Introdução: Os hospitais deparam-se cada vez mais com doentes que, tendo alta clínica, não têm condições de ordem não clínica para regressar imediatamente ao domicílio. Material e Métodos: Estudo transversal dos casos referenciados para a Rede Nacional de Cuidados Continuados Integrados durante o ano de 2016 no nosso Serviço de Urologia. Foram avaliados os tempos de espera, tipologia, motivo de referenciação e os parâmetros clínicos. Análise estatística realizada com recurso ao software IBM SPSS 24.0. Resultados: No período analisado, 2294 pacientes tiveram alta hospitalar no nosso serviço. Destes, 55 foram referenciados para a Rede Nacional de Cuidados Continuados Integrados. O tempo médio de internamento dos pacientes referenciados foi de 20,6 ± 11,4 dias enquanto o tempo médio global de internamento foi de 4,8 ± 0,9 dias. O tempo médio entre o internamento e a referenciação para a Rede Nacional de Cuidados Continuados Integrados foi de 10,7 ± 7,2 dias. O tempo entre a referenciação e a alta hospitalar foi de 10,0 ± 8,7 dias. Trinta e nove (70,9%) pacientes foram internados por patologias oncológicas. A referenciação mais frequente foi para unidades de cuidados paliativos (n = 16; 29,1%). Os pacientes referenciados para cuidados paliativos foram os que apresentaram os maiores tempos de espera entre a referenciação e a alta hospitalar efetiva, 12,2 ± 10,51 dias. Foram despendidos 289 dias de hospitalização com pacientes que não precisavam de cuidados urológicos especializados. Discussão: Para que o tempo entre a referenciação para a Rede Nacional de Cuidados Continuados Integrados e a alta hospitalar sejam diminuídos, é necessário que haja uma otimização da cooperação e coordenação entre médicos, enfermeiros e assistentes sociais. Conclusão: A identificação precoce dos doentes que necessitarão de apoio após a alta clínica permitirá uma resposta mais atempada por parte dos assistentes sociais e uma consequente melhoria do desempenho dos serviços hospitalares e satisfação dos doentes.

To evaluate the evidence that could help health system policy makers to approach the preference for same-gender urologists.We performed this systematic narrative review according to the PRISMA guidelines. We searched MEDLINE, Web of science, EMBASE, CINAHL and Google Scholar for articles focused on the preference for patient-urologist gender similarity in the male-dominated department from 1999-2019. Finally, a narrative synthesis of studies meeting the inclusion and quality criteria was conducted in accordance with the nature of the evidences. We applied a thematic analysis using inductive approach for synthesizing studies employing heterogeneous research methods and designs. Results: Of 208 titles and abstracts screened, 23 were included and three major themes including Reasons, Impacts, and Implications were identified. Overall, patients with urologic problems prefer same gender urologists and females were more likely to prefer the same gender urologist than males. Many women delays care due to a perceived lack of female urologists. The major identified reasons for the same-gender preference are religious believe, cultural background, emotional relationship, past experiences, and sensitive examinations. The results indicate that the urologists-patients gender similarity improves the quality of primary care. Our review reveled that Urologists prefer to perform more same gender-specific procedures. Beside, Female urologist and residents perceived to underestimate from their male counterparts. Conclusion: This study could help health system to honor the patient's preference for same gender urologist. The findings may help medical education and health policy makers to move the male-dominated urology departments towards a culture supportive of female urologists.

BACKGROUND The aim of this study was to assess the safety and clinical effectiveness of laparoscopic disconnected pyeloplasty in treating ureteropelvic junction obstruction (UPJO) in children. MATERIAL AND METHODS We retrospectively analyzed the clinical data of 122 young children with UPJO treated from February 2015 to February 2018 at our hospital. According to the surgery type, the patients were divided into 2 groups: a laparoscopic surgery group (group A, n=69) and a traditional open surgery group (group B, n=53). RESULTS The success rate of laparoscopic disconnected pyeloplasty was 100%, and none of the patients were converted to open surgery. The mean duration of use of painkillers was 27.6±11.3 h in group A and 58.2±18.2 h in group B (p=0.012), the postoperative hospital stay was 7.8±1.5 days in group A and 11.5±2.6 days in group B (p=0.041), and the length of the incision was 1.5±0.4 cm in group A and 5.2±1.1 cm in group B (p=0.007). The incidence rate of poor surgical wound healing was 0% in group A and 7.5% in group B (p=0.020). The incidence rate of ureteral stricture was 4.3% in group A and 3.8% in group B (p=0.874) during follow-up. The 1-year follow-up showed that both the anterior and posterior diameters and glomerular filtration rate were significantly improved from the preoperation period. CONCLUSIONS Laparoscopic disconnected pyeloplasty to treat UPJO in young children has the same early clinical effectiveness and safety as open surgery, and this procedure has the advantages of minimal trauma, quick recovery, and good cosmetic effect.

This study explores the near-term results of an effort to improve the access of a large, underserved urban population to appropriate urologic specialty care through clinical integration.

Health care is associated with a considerable climate impact and this short review describes approaches to reduce this impact. Reviews from WHO and World Bank Group end up with recommendations on low-carbon and resilient health care which is beneficial for health, economy and climate. The concept of climate-smart healthcare has been suggested as new way of describing this much needed work. In Skåne Region, Sweden a four-step method has been developed to reduce the climate impact of hospital care: to map and identify areas of greatest impact, to work with measures to reduce impact and evaluate the results. A test of this method showed a significant reduction in emission of CO2. In another project, fast-track access for patients with hematuria for diagnosis of bladder cancer showed that the median time from referral to diagnosis was reduced in comparison with conventional care with less costs and less use of resources associated with climate impact.

BACKGROUND : The acquisition of information on hospitals' quality-of-care is an important aspect for patients' decision-making, especially in the setting of elective interventions. Moreover, hospitals depend on a transparent representation of their performance in the current competitive setting. This study aims to evaluate the representation and rating of online hospital report cards with special focus on urological disease and departments. MATERIAL UND METHODS : We undertook a systematic internet search to identify eligible online hospital report cards. The quality of hospital report cards was rated on a scoring system that was developed specifically for this purpose. RESULTS: Ten of 42 (24 %) identified hospital report cards were included. Urological content was available in 9 of 10 (90 %); detailed information on surgical interventions and outcomes was given in 3 (33 %) hospital navigators. Recommended criteria for evaluation of transparency and reliability of medical information were most present in the Weisse Liste, and the hospital-navigators of AOK and BARMER. The Weisse Liste is currently the only HON-code certified hospital report card in Germany. CONCLUSION : There is a broad, but divers range of online hospital report cards available for patients in Germany. The evaluation of urological content of hospital report cards is currently feasible in terms of analysis of general parameters, but not on outcome specific quality indicators. Clarity and reduction on essential information is warranted to ensure user-oriented platforms. Informationen über die Versorgungsqualität von Krankenhäusern zu erlangen ist für Patienten ein wichtiger Faktor der Krankenhauswahl, insbesondere vor elektiven operativen Eingriffen. Auch für die Krankenhäuser selbst ist eine transparente Darstellung der Leistungserbringung im Zuge der Konkurrenzfähigkeit bedeutend. Ziel dieser Arbeit ist die systematische Darstellung und Bewertung von online Bewertungsportalen bzw. Krankenhausnavigatoren insbesondere im Hinblick auf die Abbildung urologischer Kliniken bzw. Krankheitsbilder. MATERIAL UND METHODEN : Wir führten eine systematische Internetrecherche zur Identifikation entsprechender Internetportale durch. Die Qualität der Internetportale wurde mittels eines eigens entwickelten Schemas anhand der dargestellten Informationen beschrieben und analysiert. ERGEBNISSE : Von 42 identifizierten Bewertungsportalen konnten 10 (24 %) eingeschlossen werden. Auf 9 von 10 (90 %) der eingeschlossenen Portale gab es die Möglichkeit nach urologischen Leistungsbereichen zu suchen; nur auf 3 (33 %) Navigatoren waren detailliertere Information zu Eingriffen und Ergebnisse abrufbar. Den empfohlenen Kriterien zur Transparenz und Verlässlichkeit von Gesundheitsinformationen entsprachen am deutlichsten die Weisse Liste, sowie die Krankenhausnavigatoren der AOK und der BARMER. Die Weisse Liste ist das bisher einzige HON-Code zertifizierte Bewertungsportal in Deutschland. SCHLUSSFOLGERUNG : Patienten in Deutschland können auf ein reichliches, jedoch recht unterschiedliches Angebot an Bewertungsportalen und Kliniksuchmaschinen zurückgreifen. Eine Evaluation urologischer Inhalte auf Bewertungsportalen ist als Vergleich allgemeiner Faktoren aktuell durchführbar, jedoch unzureichend für Outcome-spezifische Qualitätsindikatoren möglich. Zukünftig sollten v. a. Übersichtlichkeit und eine Reduktion der Informationsfülle im Zentrum der Aufmerksamkeit der Betreiber stehen um möglichst nutzerorientierte Plattformen bereitzustellen.

QUALITY PROBLEM As discharge letters (DL) hold important information for healthcare professionals and especially for general practitioners, rapid and efficient finalization is required. We describe a project aiming to reduce DL submission within 8 days in our Urology Department (UD), as required by the local Hospital Board (HB). INITIAL ASSESSMENT AND CHOICE OF SOLUTION A team was built in UD with staff members and one external expert to study the root causes of delayed DL creation and develop sustainable strategies to improve and monitor the process, including habits changing, training and application of Little's Law. IMPLEMENTATION AND EVALUATION The study started on January 2015 and ended up on March 2016, involving 908 and 616 DL for old and new process, respectively. The new process decreased the average delay of DL completion from 24.88 days to 14.7 days. Standard deviation of total average delay for DL completion fell from 10.1 days to 7.5 days. We identified four steps needed to DL creation and allowed maximum 2 days for every step completion. No additional resources were employed. LESSONS LEARNED We were able to improve the process of DL creation, by analysing its steps and reducing their variability. This can be easily transposed to other medical departments.

BACKGROUND Antimicrobial resistance data from surveillance networks are frequently do not accurately predict resistance patterns of urinary tract infections at the bedside. OJECTIVE To determine simple patient- and institution-related risk factors affecting antimicrobial resistance patterns of Escherichia coli urine isolates. METHODS From January 2012 to May 2015 all consecutive urine samples with significant growth of E. coli (≥103 CFU/ml) obtained from a tertiary care hospital were analysed for antimicrobial susceptibility and related to basic clinical data such a patient age, ward, sample type (catheter vs non-catheter urine). RESULTS Antimicrobial susceptibility testing was available for 5246 E. coli urine isolates from 4870 patients. E. coli was most commonly resistant to amoxicillin (43.1%), cotrimoxazole (24.5%) and ciprofloxacin (17.4%). Resistance rates were low for meropenem (0.0%), fosfomycin (0.9%) and nitrofurantoin (1.5%). Significantly higher rates of resistance to ciprofloxacin (32.8 vs 15.8%) and cotrimoxazole (30.6 vs 23.9%) were found in urological patients compared with patients on other wards (p

The Department of Urology, Municipal Hospital, Thalkirchnerstr. 48, Munich (1938-1984) is justly reputed as one of the germ-cells of German Urology, not only by Prof. May's protagonism for an independent urology, but also by the multiple, especially technical innovations under the successors, which are fundamentals for the modern urology.

To evaluate the suitability of empirical antibiotic therapy in HAIs and the antibiotic resistance patterns of the responsible microorganisms, as well as the incidence of mortality and risk factors involved.A prospective observational study was carried out on patients of both sexes older than 16years, admitted by any urological process during a period of 4years. The incidence and characteristics of HAIs, as well as the causative organism and its resistance, the initial empirical antibiotic therapy and its modification, if required, and mortality rates are analysed.Out of 6,546 patients, 6.3% suffered HAIs, 70.5% corresponding to urinary tract infection and 22.1% to infection of the surgical wound. E.coli, Enterococcus spp., Klebsiella spp. y P.aeruginosa were the most frequently implicated (25.1%, 17.5%, 13.5% and 12.3%, respectively). E.coli and Klebsiella spp. were producers of extended-spectrum beta-lactamases (ESBL) in 24.7% and 47.8%, respectively. 4.3% of Klebsiella and 33.3% of Pseudomonas were carbapenems-resistant. The overall resistance to quinolones was approximately 50%. The most commonly used antibiotics for empirical therapy were cephalosporins of 3rd and 4th generation (33.6%) and carbapenems (28.2%). An overall rate of adequacy of empirical antibiotic therapy of 82.9% was obtained. The mortality rate in patients with HAIs was 2.2%, compared with 0.3% in patients without infection. In a multivariate analysis, the variables associated with the highest mortality risk were the isolation of ESBL-producing enterobacteria and the inadequate empirical antibiotic treatment.The selection of empirical antibiotic therapy was quite accurate. An increase in HAIs by multiresistant microorganisms, such as ESBL Enterobacteria or multiresistant P.aeruginosa is being observed. The mortality risk increases with inadequate initial empirical antibiotic therapy or when the responsible microorganism is an ESBL enterobacteria.

Many hospitals encounter surgery cancelations for various reasons. We present a methodology applying data mining and simulation to optimize operating room (OR) scheduling in a urology department in West China Hospital. To the best of our knowledge, this is 1 of the first efforts to seek an optimal schedule solution based on cancelation risk of elective surgeries as well as OR allocation between elective and nonelective surgeries. First, chi-square test and random forest prediction modeling were used to predict potential elective surgeries with high cancelation risk, and the factors, including surgeon, number of days since admission of patient, first surgery or not, etc., that influence elective surgery cancelation were identified. Second, a simulation technology was designed to compare 7 different scheduling strategies. The results demonstrated that for elective surgery, cancelation rate low surgery first outperformed the others and increased the productivity of the ORs from 72% to 83%, while for nonelective surgery performed in a separate OR, there was no improvement because the supply was greater than necessary at present. However, in total, the selected strategies led to 7% higher productivity.

The intravesical administration of hazardous drug products is a standard practice in the urology setting, which potentially exposing medical personnel to these drug products. It was deemed necessary to have a consensus document among the scientific societies involved (the Spanish Urological Association and the Spanish Society of Hospital Pharmacy) that collects the best available evidence on the safest handling possible of dangerous drug products in the setting of urology departments.We reviewed the legislation and recommendations on the handling of dangerous drug products, both at the national and international level.There is national legislation and regulations for protecting workers who handle dangerous drugs and products, as well as recommendations for handling to protect both the product and workers.Following the strategic lines of the European Parliament for 2014- 2020 in the chapter on occupational safety and health, the Spanish Urological Association and the Spanish Society of Hospital Pharmacy proposed a series of actions that decrease the risks of exposure for practitioners and caregivers involved in the handling of these products.After this review, 19 recommendations were established for handling dangerous drug products, which can be summarised as the need to train all individuals involved (from management teams to patients and caregivers), adopt systems that prevent contaminating leaks, implement exposure surveillance programmes and optimise available resources.Objetivo: La administración intravesical de medicamentos peligrosos es una práctica habitual en el ámbito de la urología, con posible exposición del personal sanitario a dichos medicamentos. Se considera necesario disponer de un documento de consenso entre las sociedades científicas implicadas —Asociación Española de Urología y Sociedad Española de Farmacia Hospitalaria— que recoja la mejor evidencia disponible para el manejo, de la forma más segura posible, de medicamentos peligrosos en el ámbito de los servicios de Urología.Método: Se ha realizado una revisión de la legislación y de las recomendaciones sobre el manejo de medicamentos peligrosos tanto a nivel estatal como internacional.Resultados: Se dispone de legislación nacional y de normativas para la protección de los trabajadores que manipulen medicamentos y productos peligrosos, así como recomendaciones de manipulación para la protección tanto del producto, como de los trabajadores.Discusión: Siguiendo las líneas estratégicas del Parlamento Europeo para el período 2014-2020 en el capítulo de seguridad y salud laboral, la Asociación Española de Urología y la Sociedad Española de Farmacia Hospitalaria proponen una serie de actuaciones que hagan disminuir los riesgos de exposición de los profesionales y cuidadores implicados en su manejo. Conclusiones: Tras esta revisión se establecen 19 recomendaciones para el manejo de medicamentos peligrosos que pueden resumirse en la necesidad de formación de todas las personas implicadas (desde los equipos directivos hasta los pacientes y cuidadores), la adopción de sistemas que no permitan fugas contaminantes, programas de vigilancia de las exposiciones y optimización de los recursos disponibles.

During the last decades, pharmaceutical care services have been developed and implemented to optimize drug therapies and ensure medication safety. To investigate the need for pharmaceutical care services, drug-related problems can be measured.Thus, the aim of this study was to analyse number, type and occurrence of drug-related problems in different clinical departments.A pharmaceutical care service was established on general wards in Urology, Neurology and Gastroenterology at the University Hospital RWTH Aachen, Germany.For each of a total of 306 patients, a pharmacist conducted an extended medication history, performed medication reconciliation, conducted medication safety checks and if drug-related problems were discovered, gave valid recommendations to the attending healthcare team. Drug-related problems were classified using the APS-Doc system. For statistical analyses, SAS(®) 9.1.3, SAS Institute, Cary NC, USA was applied. The project was approved by the local ethics committee.Type, occurrence and frequency of DRP in different medical departments.On average, 2.3 drug-related problems per patient were documented for all three departments. Drug-related problems were found in each category of the APS-Doc system. The most pronounced drug-related problems found were drug-drug interactions (34.6 %). 37 % of the identified drug-related problems occurred before hospital admission, 27 % during transitional care, and 36 % on the ward. Subgroup analysis revealed specific drug-related problem patterns for each clinical department. The number of drug-related problems was found to be associated with the number of drugs and age.Drug-related problems frequently occur in all investigated clinical departments. A holistic pharmaceutical care service could be an option to address this issue. In case of limited resources, individual drug-related problem patterns can be used as a basis for a tailored pharmaceutical care service. As number of drugs and age have been shown to be significant risk factors, it is crucial that the healthcare team including the pharmacist pays special attention to elderly patients and those with polymedication.

Our institution has recently developed a rapid access outpatient clinic to investigate men with testicular lumps and/or pain suspicious for testicular cancer (TCa). To present our experience after 12 months. All referrals to the rapid access testicular clinic (RATC) clinic were prospectively analysed from 01/01/2013 to 01/01/2014. The primary outcome variable was incidence of TCa in the referred patient cohort. Secondary outcome variables were waiting times prior to clinical review and waiting times prior to radical orchidectomy in patients diagnosed with TCa. Seventy-four new patients were referred to the RATC during the 1-year period and the mean age was 34 (range 15–81 years). TCa was the most common diagnosis and was found in 18 (25 %) patients. Patients diagnosed with TCa underwent radical orchidectomy, a median of 3 (range 1–5) days after their initial GP referral. Patients requiring surgical intervention for benign scrotal pathology underwent their procedure a median of 32 (range 3–61) days after their initial referral. Of the 18 patients diagnosed with TCa, 9 (50 %) were diagnosed with a seminomatous germ cell tumour on histopathology. The RATC is a new initiative in Ireland that provides expedient and definitive treatment of patients with newly diagnosed TCa. Early treatment will ultimately improve long-term prognosis in this patient cohort.

BACKGROUND Ward rounds are the traditional process by which clinical information is interpreted and management plans made in the inpatient setting and the only time during which patient-doctor interaction can reliably occur. Efforts to improve quality and safety have started looking at the ward round but this has mainly been in the acute medical setting. OBJECTIVE To begin the quality improvement process for Urological ward rounds. METHODS Twenty indicators thought to relate to quality were recorded for every weekday ward round by the Urology team for one month. RESULTS Twenty ward rounds, 93 patient encounters, were reviewed. A consultant was present for 37% of the patient encounters. 84% of observation charts were reviewed; drug charts 28% and antibiotics 70%. Plans were communicated to the doctors, patient and nursing staff. All notes were typed directly onto the electronic system, 20% of notes were checked by the lead clinician. Mean time per patient was 6 minutes. CONCLUSIONS By starting a discussion about ward rounds we aim to align the process with the broader values of the organisation. Ward rounds can be the cornerstone of delivering safe, clean and personal care and measuring this process is vital to understanding efforts to improve them.

The purpose of this study was the evaluation of trends in the antimicrobial resistance of Pseudomonas aeruginosa from intensive care unit (ICU) patients and urology patients in the Netherlands. From 1998 to 2010, 1,927 consecutive P. aeruginosa isolates from ICU (n = 1,393) and urology service patients (n = 534) of 14 university and referral hospitals all over the Netherlands were collected and their susceptibility to relevant antibiotics was determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Over time, a significant upward trend in the resistance of P. aeruginosa strains collected from ICUs to piperacillin (1.2 % to 10.6 %, p = 0.0175), piperacillin-tazobactam (1.2 % to 12.1 %, p = 0.0008), ceftazidime (1.2 % to 7.8 %, p = 0.0064), cefepime (4.8 % to 6.4 %, p = 0.0166), imipenem (6 % to 19.1 %, p

INTRODUCTION All cancer patients are discussed in multidisciplinary team meetings (MDTs). Certain patients are referred to the Central MDT based on specific national criteria. We wanted to see whether the Central MDT aided in the decision-making process above that of the Local MDT alone. PATIENTS AND METHODS All MDT forms (local and central) for 2007 were retrospectively reviewed. RESULTS A total of 217 patients were reviewed at the Local MDT. Of these 217 cases, 102 (47.0%) cases were referred to the Central MDT and 15 of the 102 (14.7%) cases were awaiting investigations at the time of the Local MDT and were, therefore, excluded. For the prostate cancer cases (n = 67), the Central MDT did not change outright the Local MDT decision in any case, but in 6 of 67 (9.0%), advised/excluded patients from clinical trials. For bladder cancer cases (n = 19), 4 of 19 (21.0%) patients had their management changed by the Central MDT. The one kidney cancer case had its Local MDT decision changed by the Central MDT. CONCLUSIONS This audit suggests that the Central MDT plays a useful role in the decision-making process for bladder and kidney cancers, and helps determine eligibility for clinical trials in metastatic prostate cancer patients. Its value over the Local MDT alone in the decision-making process for non-metastatic prostate cancer is questionable.

The aim of this study was to inform health policy by demonstrating the benefits of an electronic referral (e-referral) system to study inpatient referrals to urology departments. London North West Healthcare NHS Trust has over 800 beds and several secondary and tertiary care services. In January 2014, we designed an e-referral form to requisition urology input for in-patients using the Integrated Clinical Environment™ (ICE) platform. We retrospectively reviewed e-referral records from February to December 2014 for patient demography, the referring service and disease groups triggering a referral. There were 1192 referrals. There was a median of 107 e-referrals per month (IQR 97–123, range 91–132) and 4 per day (IQR 2–6, range 0–12). Weekend e-referrals were 127 (median 1, IQR 0–2, range 0–5) with 1065 e-referrals on weekdays (median 4, IQR 3–6, range 0–12). A total of 848 (71.1 %) patients were male, and 344 (28.9 %) were female. Patients’ mean age was 63 (SD 21) years. Almost half (550, 46 %) were acute referrals. Amongst the acute referrals, the majority (466, 84.7 %) arose from A&E. From the non-acute conditions, 381 (59.3 %) patients were from the medical specialities and 246 (38.3 %) from surgical disciplines. The three largest disease categories were urolithiasis (287, 24.1 %), haematuria (185, 15.5 %) and for ex-catheterisation (102, 8.6 %). A qualitative review showed the strengths and weaknesses of the system, enabling improvements in operational efficiency. An e-referral system monitors activity accurately. Systemic improvement in referral pathways would lead to better patient care and enable services to factor in the unseen component of workload and prompt realistic staffing.

The authors studied the publications written by the staff of the University Department of Urology in Budapest, Hungary between 1946 and 1956. The collection was contributed on the occasion of Professor Babics's 10-year-long chairmanship. Over a period of 10 years, 214 papers were published by 15 urologists, including 3 books and 3 PhD theses; 16 papers were published in German, 22 in English, 2 in French, and 1 in Italian. The most frequent topic of the papers (26) was basic science (e.g., ureter motility, lymph circulation, intrarenal pressure condition). Other papers dealt with nephrology, artificial kidneys, TURP, and nephron-sparing renal surgery. Some articles examined various types of malignant tumors and benign prostatic hyperplasia, while 17 publications focused on the topic of andrology. Tuberculosis was also discussed by the authors. Despite political isolation, the communist dictatorship, poverty, the lack of health equipment, physicians educated before WWII with their work morality and hard work managed to perform contemporary clinical and basic scientific research.