RESUMO
Proposal: To highlight the indications for emergency surgery during the 2019 Coronavirus pandemic (COVID-19) that support recommendations published in mid-March 2020 by the American Confederation of Urology on its website. MATERIALS AND METHODS: A bibliographic search was conducted in PubMed and Cochrane Library to perform a non-systematic review, using key words: Urology, Emergency and COVID-19, to determine recommendations for patients that should receive emergency care due to urological pathology. RESULTS: The main recommendations and protocols in the management of different urological emergencies during the COVID-19 pandemic are reviewed and discussed. CONCLUSIONS: We are living a new condition with the COVID-19 pandemic, which obliges urologists to conform to the guidelines that appear on a daily basis formulated by multidisciplinary surgical groups to manage urological emergencies. Consequently, in this time of health crisis, we must adapt to the resources available, implementing all biosecurity measures to protect patients and all health personnel who are in charge of patient management.
Assuntos
Pandemias , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/psicologia , Urologia/normas , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pneumonia Viral/epidemiologia , SARS-CoV-2 , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Urologia/tendênciasRESUMO
ABSTRACT Proposal: To highlight the indications for emergency surgery during the 2019 Coronavirus pandemic (COVID-19) that support recommendations published in midMarch 2020 by the American Confederation of Urology on its website. Materials and Methods: A bibliographic search was conducted in PubMed and Cochrane Library to perform a non-systematic review, using key words: Urology, Emergency and COVID-19, to determine recommendations for patients that should receive emergency care due to urological pathology. Results: The main recommendations and protocols in the management of different urological emergencies during the COVID-19 pandemic are reviewed and discussed. Conclusions: We are living a new condition with the COVID-19 pandemic, which obliges urologists to conform to the guidelines that appear on a daily basis formulated by multidisciplinary surgical groups to manage urological emergencies. Consequently, in this time of health crisis, we must adapt to the resources available, implementing all biosecurity measures to protect patients and all health personnel who are in charge of patient management.
Assuntos
Humanos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/normas , Guias de Prática Clínica como Assunto , Pandemias , Urologistas/psicologia , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Urologia/tendências , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Infecções por Coronavirus/epidemiologia , Betacoronavirus , SARS-CoV-2 , COVID-19RESUMO
ABSTRACT Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID-19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID-19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID-19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID-19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.
Assuntos
Pneumonia Viral/complicações , Procedimentos Cirúrgicos Urológicos/métodos , Urologia/normas , Urologia/tendências , Laparoscopia/métodos , Infecções por Coronavirus/complicações , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Procedimentos Cirúrgicos Robóticos/métodos , Urologistas , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Urológicos/tendências , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/epidemiologia , Fluxo de Trabalho , Procedimentos Cirúrgicos Robóticos/tendências , Betacoronavirus , SARS-CoV-2 , COVID-19RESUMO
Known laparoscopic and robotic assisted approaches and techniques for the surgical management of urological malignant and benign diseases are commonly used around the World. During the global pandemic COVID19, urology surgeons had to reorganize their daily surgical practice. A concern with the use of minimally invasive techniques arose due to a proposed risk of viral transmission of the coronavirus disease with the creation of pneumoperitoneum. Due to this, we reviewed the literature to evaluate the use of laparoscopy and robotics during the pandemic COVID19. A literature review of viral transmission in surgery and of the available literature regarding the transmission of the COVID19 virus was performed up to April 30, 2020. We additionally reviewed surgical society guidelines and recommendations regarding surgery during this pandemic. Few studies have been performed on viral transmission during surgery. No study has been made regarding this area during minimally invasive urology cases. To date there is no study that demonstrates or can suggest the ability for a virus to be transmitted during surgical treatment whether open, laparoscopic or robotic. There is no society consensus on restricting laparoscopic or robotic surgery. However, there is expert consensus on modification of standard practices to minimize any risk of transmission. During the pandemic COVID19 we recommend the use of specific personal protective equipment for the surgeon, anesthesiologist and nursing staff in the operating room. Modifications of standard practices during minimally invasive surgery such as using lowest intra-abdominal pressures possible, controlled smoke evacuation systems, and minimizing energy device usage are recommended.
Assuntos
Infecções por Coronavirus/complicações , Transmissão de Doença Infecciosa/prevenção & controle , Laparoscopia/métodos , Pandemias , Pneumonia Viral/complicações , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Urologistas , Urologia , Betacoronavirus , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Robóticos/tendências , SARS-CoV-2 , Procedimentos Cirúrgicos Urológicos/tendências , Urologia/normas , Urologia/tendências , Fluxo de TrabalhoRESUMO
OBJECTIVE: To define the relationship between urology relative value units (RVUs) and measures of surgical complexity and physician workload. Secondary objectives include: (1) identifying procedures with outlying RVU values for their measures of surgical complexity and workload; and (2) calculating projected RVU values for these procedures. METHODS: We obtained surgical case data for 71 urology current procedural terminology (CPT) codes from the 2017 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Pearson correlation coefficients were calculated to measure the association between mean total work RVU and operative time, length of hospital stay, serious adverse events, readmissions, and mortality. We developed a multivariable regression model to predict mean total work RVU from these measures. Studentized residuals were used to identify outlying CPT codes for both bivariable and multivariable regression models, and empirically derived RVU values from complexity and work effort metrics were estimated. RESULTS: We analyzed 71 urology CPT codes encompassing 55,068 cases. RVUs correlated well with median length of hospital stay (Râ¯=â¯0.81), median operative time (Râ¯=â¯0.92), serious adverse events (Râ¯=â¯0.83), and readmissions (Râ¯=â¯0.74). RVUs were poorly correlated with mortality (Râ¯=â¯0.34). Outlying procedures identified using the multivariable model were retroperitoneal lymph node dissection (projected +21.09 RVUs), laparoscopic ureteroneocystotomy (projected -12.34 RVUs), and cystectomy with bilateral pelvic lymphadenectomy (projected +9.37 RVUs). CONCLUSION: Urology work RVUs correlate more with operative time than other measures of surgical complexity and physician workload. There exist several significant outlying procedures for various work measures. Incorporating objective work data may improve RVU assignments in the future.
Assuntos
Eficiência , Duração da Cirurgia , Médicos , Complicações Pós-Operatórias , Doenças Urológicas , Procedimentos Cirúrgicos Urológicos , Carga de Trabalho/estatística & dados numéricos , Current Procedural Terminology , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Gravidade do Paciente , Readmissão do Paciente/estatística & dados numéricos , Médicos/organização & administração , Médicos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade , Escalas de Valor Relativo , Estados Unidos , Doenças Urológicas/epidemiologia , Doenças Urológicas/cirurgia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/mortalidade , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/métodos , Urologia/normasRESUMO
BACKGROUND: Urinary incontinence is a common complaint in all parts of the world, cause of distress, as well as significant costs for both individuals and society. The aim of this study will be to evaluate the rigor of the development of clinical practice guidelines and to identify the recommendations of interventions for urinary incontinence in adult women. METHODS: In this systematic review, clinical practice guidelines will be identified using a prospective protocol through a systematic search of: MEDLINE (via Ovid); EMBASE (Excerpt Medical Database, via Ovid); Web of Science and Virtual Health Library. Specific databases of guidelines for clinical practice will also be searched (National Institute for Health and Care Excellence, American Urological Association, and others). Reviewers, independently and in duplicate, will assess the quality of the guidelines using the Appraisal of Guidelines Research and Evaluation (AGREE II). The results will be checked for discrepancies. Differences between the scores equal to or greater than 2 will be considered as discrepant and the final result will be decided by consensus. A comparison of the recommendations of interventions and information about the level of evidence, the degree of recommendation, the level of agreement and the level of acceptance will be described. This step will also be done independently and in duplicate, and the result will be decided by consensus. The results will be presented in tables and the descriptive statistics will be calculated for all domains of the AGREE II instrument as mean (standard deviation) and median (interquartile range). RESULTS: The results derived from this study will increase the knowledge about the development of recommendations guidelines for urinary incontinence of high methodological rigor. This study may also identify key areas for future research. CONCLUSION: This study may guide health professionals, policy makers, and health policy managers in choosing the guidelines for recommendation in clinical practice. PROTOCOL REGISTRATION: PROSPERO - CRD42018116517.
Assuntos
Guias de Prática Clínica como Assunto , Incontinência Urinária , Urologia/normas , Feminino , Humanos , Masculino , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
ABSTRACT Minimally invasive urologic surgery has been developing in Brazil and now is a routine part of care in many regions and patients with different conditions benefit from it. Training in laparoscopic and robotic surgery has evolved and concerns exist both over the quality of surgical training and the practical effect on results of the urological training. This is an unprecedented study which undertook a census to determinate the current state of laparoscopic and robotic urological practice and to know the mains barriers to adequate practice in Brazil. In august 2017, surveys, consisting of an anonymous questionnaire with 15 questions, were sent via internet to the mailing list of the Brazilian Society of Urology (SBU). With these data, activities related to laparoscopy and robotic surgery of our urologists and the mains difficulties and barriers to practice laparoscopy and robotic surgery were evaluated. In our survey, 413 questionnaires were completed. Majority of the responders were currently working in the southeast region of Brazil (52.1%) and 75.5% of the surgeons performed laparoscopic surgery while, only 12.8%, robotic surgery. The lack of experience on the technique and the lack of equipment were the mains barriers and difficulties for not executing laparoscopic and robotic surgeries, respectively. Proper longitudinal training and access to good equipment in minimally invasive surgery are still barriers for urologists in our country.
Assuntos
Humanos , Procedimentos Cirúrgicos Urológicos/normas , Padrões de Prática Médica/normas , Laparoscopia/normas , Procedimentos Cirúrgicos Robóticos/normas , Urologistas/normas , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/normas , Padrões de Prática Médica/estatística & dados numéricos , Brasil , Inquéritos e Questionários , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Urologistas/estatística & dados numéricosRESUMO
Although blood pressure control is a major goal in chronic kidney disease, no worldwide overview of either its achievement or antihypertensive prescriptions is currently available. To evaluate this we compared crude prevalence of uncontrolled blood pressure among 17 cohort studies, including 34 602 individuals with estimated glomerular filtration rate under 60 ml/min/1.73 m2 and treated hypertension across four continents, and estimated observed to expected prevalence ratios, adjusted for potential confounders. Crude prevalence of blood pressure of 140/90 mm Hg or more varied from 28% to 61% and of blood pressure of 130/80 or more from 54% to 84%. Adjusted prevalence ratios indicated poorer hypertension control than expected in cohorts from European countries, India, and Uruguay, and better control in patients from North American and high-income Asian countries. Four antihypertensive drug classes or more were prescribed to more than 30% of participants in North American and some European cohorts, but this practice was less common elsewhere. Renin angiotensin-aldosterone system inhibitors were the most common antihypertensive drugs, prescribed for 54% to 91% of cohort participants. Differences for other drug classes were much stronger, ranging from 11% to 79% for diuretics, 22% to 70% for beta-blockers, and 27% to 75% for calcium-channel blockers. The confounders studied explain only a part of the international variation in blood pressure control among individuals with chronic kidney disease. Thus, considerable heterogeneity in prescription patterns worldwide calls for further investigation into the impact of different approaches on patient outcomes.
Assuntos
Anti-Hipertensivos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Hipertensão/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Insuficiência Renal Crônica/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/normas , Ásia/epidemiologia , Pressão Sanguínea/efeitos dos fármacos , Pressão Sanguínea/fisiologia , Europa (Continente)/epidemiologia , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , América do Norte/epidemiologia , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Prevalência , Insuficiência Renal Crônica/tratamento farmacológico , Insuficiência Renal Crônica/fisiopatologia , Urologia/normas , Urologia/estatística & dados numéricos , Uruguai/epidemiologiaRESUMO
Minimally invasive urologic surgery has been developing in Brazil and now is a routine part of care in many regions and patients with different conditions benefit from it. Training in laparoscopic and robotic surgery has evolved and concerns exist both over the quality of surgical training and the practical effect on results of the urological training. This is an unprecedented study which undertook a census to determinate the current state of laparoscopic and robotic urological practice and to know the mains barriers to adequate practice in Brazil. In august 2017, surveys, consisting of an anonymous questionnaire with 15 questions, were sent via internet to the mailing list of the Brazilian Society of Urology (SBU). With these data, activities related to laparoscopy and robotic surgery of our urologists and the mains difficulties and barriers to practice laparoscopy and robotic surgery were evaluated. In our survey, 413 questionnaires were completed. Majority of the responders were currently working in the southeast region of Brazil (52.1%) and 75.5% of the surgeons performed laparoscopic surgery while, only 12.8%, robotic surgery. The lack of experience on the technique and the lack of equipment were the mains barriers and difficulties for not executing laparoscopic and robotic surgeries, respectively. Proper longitudinal training and access to good equipment in minimally invasive surgery are still barriers for urologists in our country.
Assuntos
Laparoscopia/normas , Padrões de Prática Médica/normas , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Urológicos/normas , Urologistas/normas , Brasil , Humanos , Laparoscopia/métodos , Laparoscopia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Inquéritos e Questionários , Procedimentos Cirúrgicos Urológicos/métodos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologistas/estatística & dados numéricos , Urologia/normasRESUMO
ABSTRACT Purpose: Although the worldwide percutaneous nephrolithotomy (PCNL) practice pat- terns determined via a survey sent to members of the Endourological Society have been published, differences in PCNL practice patterns among Latin American urologists based on endourological or lithiasis training have not been published. To determine the PCNL practice patterns among Latin American urologists with and without training in endourology. Materials and Methods: The SurveyMonkey® web platform was used to develop a 27-item survey on PCNL for the treatment of renal stones, and the survey was sent via e- -mail and other electronic media to 2000 urologists from 15 Latin American countries. Endourology-trained (group 1) and nontrained urologists (group 2) were analyzed. The group results were compared using the chi-squared and Fisher's exact tests. SPSS version 20 for Windows was used for all analyses. Results: A total of 331 urologists responded to the survey (rate of 16.55%): 221 (66.7%) in group 1 and 110 (33.2%) in group 2). In groups 1 and 2, 91.9% and 63.2% performed PCNL, respectively: 85.1% and 58.5% used preoperative tomography, respectively; 12.7% and 4.7% used preoperative nephrolitometry nomograms, respectively: 45.2% and 32.1% used endoscopic combined intrarenal surgery, respectively: 68.3% and 38.7% used mul- tiple percutaneous tract realization, respectively: and 19.9% and 5.7% used minimally invasive PCNL, respectively (all p=0.0005). Conclusions: Statistically significant differences were observed in PCNL practice patterns of Latin American urologists with and without training in endourology. Specific training in endourology significantly influence the practice patterns of Latin American urologists.