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Iranian Urology Association Coronavirus Disease 2019 (COVID-19) Taskforce Pamphlet (IUA-CTP) Recommended Practice based on National Epidemiologic Analysis

Seyed Mohammad Ghahestani, Milad Bonakdar Hashemi, Naser yousefzadeh Kandevani, Nasrin Borumandnia, Mehdi Dadpour, Farzaneh Sharifiaghdas

Since the emergence of Covid19 epidemics different guidelines and protocols have been published by Urology associations. Most of these recommendations have focused on the aptitude of any disease or condition for postponement. With the evolution of the outbreak, it is clear that postponement of procedures is not the policy we can rely on exclusively. We must know where do we stand? Where are we going in our country? How useful our recommendations have been for urology practitioners? We try to draw a clearer although-to some extent- conjectural picture and to adjust our protocols to this picture of outbreak evolution. Assuming that anything in this predicament is subject to unexpected changes.

For these goals, we raise these arguments in three sections. First, where do we stand and where are we going? Explaining the present situation and best available statistics of the disease, the velocity the disease is spreading and our approximate predicted date its subsidence or partial remission.

In a web form survey, we tried to evaluate that in the absence of a clear picture of outbreak progress in a specific area, how useful experts’ points of view will be for the urologists working in non-referral centers especially in relevance to equivocal and challenging cases. Will there be any significant difference at all?

In the third section, we try to give the plot to guide scheduling or postponing procedures in any given are according to the level of involvement. Here we considered both the characteristics of the special urology condition and also the situation and progress of the outbreak in that area

Ramadan Fasting and Kidney Stones: A Systematic Review

Mohsen Amjadi, Farzin Soleimanzadeh, Hamidreza Ghamatzadeh , Sakineh Hajebrahimi, Hossein Hosseinifard, Hanieh Salehi Pourmehr, Fateme Tahmasbi

Purpose: Ramadan fasting in Muslims may contain several hours of abstaining from food and drinking in any kind. This can potentially increase the risk of urinary stone disease. Current literature on possible effects of Ramadan fasting on urolithiasis is rather limited. Having the gap in scientific background, we decided to evaluate the available comparative information in this systematic review. 

Materials and Methods: We included all studies comparing fasting and non-fasting conditions, studies evaluating stone formation and clinical manifestations of kidney stone disease. All the English studies published from January 1980 to the end of 2019 were included. The exclusion criteria were as followed: fasting out of Ramadan, non-comparative studies, animal studies, patients with bladder stones and studies evaluating conditions that are only indirectly related to the stone formation or clinical manifestations of it. Applying the Joanna Briggs Institute (JBI) methodology for systematic review showed the quality of included studies was not high.

Results: Only five studies remained after exclusion. Meta-analysis was not applicable due to the diversity in methods and evaluated population. 

Conclusion: Main trend of the included studies is toward showing no difference between fasting and non-fasting conditions in terms of renal stone formation. However, generalization of the findings to greater populations should be applied carefully considering the heterogeneity of results and quality of studies.

Background: Partial adrenalectomy (PA) is an emerging modality typically performed for the treatment of hereditary and sporadic bilateral tumors, to reduce the risk of adrenal failure. In this study, we evaluated the recurrence and functional outcomes after partial and total adrenalectomy (TA).

Materials and methods: From March 2005 to July 2018, 284 patients with functional tumor or > 5 cm adrenal mass underwent clipless and sutureless laparoscopic partial or total adrenalectomy (PLA and TLA). Patients with a pathological diagnosis of pheochromocytoma, Cushing or Conn’s disease and more than two yea follow up were included in this study.  Pre-operative and operative variables were collected retrospectively and functional outcomes and recurrence were gathered prospectively.

Results: One hundred forty patients (mean age: 43±5.1years) were included in the study. PLA and TLA were performed for pheochromocytoma (total n=78; PLA=12 (15%), TLA=66 (85%)), Cushing syndrome (toal n=17; PLA = 4 (24%), TLA = 13 (76%)), and Conn’s disease (total n=45; PLA=7 (16%), TLA=38 (84%)). In pheochromocytoma patients, improvement of hypertension, palpitation, and headache was not different between patients who underwent PLA versus TLA (all P > 0.05).  Two recurrences were observed in patients with pheochromocytoma and they had undergone TLA. In patients with Cushing disease, central obesity, fascial plethora and hypertension were improved in all patients six months after treatment, muscle weakness was improved one year after surgery, and acne and hyperpigmentation only improved two years after surgery. Length of time for resolution of symptoms was not different in patients who underwent PLA versus TLA. In Conn’s disease hypertension was resolved in all patients and no patient required potassium supplements post-operatively. In follow up no recurrence was observed in patients with a pathological diagnosis of Cushing or Conn’s disease.

Conclusion: In our experience, PLA can provide excellent control of the symptoms parallel with TLA and with no statistically significant difference in recurrence making PLA an attractive option in patients with an adrenal mass.

INTRODUCTION: On 11 March 2020, the World Health Organization (WHO) declared a pandemic. Since then hospitals have reduced inpatient and outpatient workflow and cancelled or suspended all non-emergent and routine surgical procedures. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological services.

MATERIALS AND METHODS: We retrospectively studied the data from January-May 2020 and 2019 about the variables: number of operations, waiting list, visits in outpatient department, bladder instillations and urological emergencies and admission rates.

RESULTS: Cancer cases high-risk for stage progression and surgical emergencies, were elected to proceed directly to treatment. The number of the operations was reduced by 43-65% from March-May 2020. Our surgical list had a waiting time of 6-8 weeks before the pandemic and now the waiting time has expanded to 12 weeks. Urological emergencies were reduced about 23-57%. Admission rates were dropped 10-51%. Visits in outpatient clinics were reduced 100-50% and outpatient procedures for elective cases were all deferred. Unfortunately, the hospital did not offer synchronous telehealth appointments. Bladder instillations of BCG or chemotherapeutics were not suspended but start of new cases had a delay of 2-3 weeks. There were no cases of COVID-19 in our department.

CONCLUSION: All the variables of our urologic practice were affected during the COVID era. The impact of the reduced model of outpatient and inpatient workflow on the health of our patients is unknown. However, longer waiting lists are expected. It is obvious that healthcare providers should adopt a new healthcare model.