LETTER TO EDITOR
Year : 2020  |  Volume : 36  |  Issue : 3  |  Page : 234-235

COVID-19: Urologist's perspective and urology practices

Deepak Kumar Ranjan¹, Gautam Ram Choudhary^2
1 Department of Urology and Renal Transplant, Yashoda Hospital, Secunderabad, Telangana, India
² Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Dr. Gautam Ram Choudhary
Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/iju.IJU_126_20

1. Practice of social distancing should be strictly followed everywhere at all times. Physical consultations should be restricted to only emergency conditions. Telemedicine facilities should be employed for routine consultation as per directions by the Government of India.^[1] While examining patients, urologists should wear personal protective equipment (PPE) as per recommendations.^[2] Patients suspicious of COVID-19 should be promptly sent to designated facilities for screening, isolation, and treatment. One patient-one room policy is preferable for hospitalized patients. We should take our unavoidable patient interactions as opportunities to spread correct information about COVID-19 to our patients and their attendants. Nonsteroidal anti-inflammatory drugs (NASIDs) are routinely used in emergency and postoperative settings for effective pain management. Although no conclusive evidence is available, supporting these concerns, it is preferable to use paracetamol in COVID-19 patients instead of NSAID ^[3]
2. Surgeries should be rescheduled as per the Urological Society of India's recommendation.^[4] All the members of the surgical team should adopt adequate protection devices. Number of personnel in the operating room should be kept as low as possible. If the use of electrocautery is unavoidable, then the power setting should be kept low, and spray mode should be avoided. Devices with smoke evacuation filters should be used in laparoscopic procedures.^[5] Even though there is no evidence of viral transmission via urine, urologists should take all precautions necessary to avoid contact with urine while performing a procedure. Similar care should be taken while handling bowel during surgery, as the presence of the virus in stools has now been reported.^[6] According to the American Society of Transplantation recommendations, if a prospective transplant recipient has no urgent need to undergo the transplant, the procedure should be postponed. We should also discourage existing transplant recipients from visiting hospitals for routine checkups
3. Owing to lockdown, academic activities should not suffer; virtual academic events should be continued, simultaneously we should keep ourselves updated with resources (guidelines published by various urological associations, videos, podcasts, etc.). We should also use this time to complete our pending research works and writing the article, which previously due to busy practice, we were not able to complete
4. As there will not be any elective surgeries or outpatient visits, there is no need for the full quota of trainees and consultants to report on duty on a daily basis. 30% of them can work for 1 week followed by 2 weeks of self-quarantine. By doing so, we will be better prepared for any overwhelming situation when it arises, and unnecessary wastage of precious PPE can be limited
5. We should also be ready to help our colleagues in various departments who are now primarily dealing with COVID-19 patients. For that, we have to be well informed and trained about various aspects of disease management starting from the correct way of donning and doffing PPE to safe intubation and mechanical ventilation.^[1]

References

1.	Ministry of Health and Family Welfare and Indian Council of Medical Research Updates on SARS-CoV-2 (COVID-19). Available from: http://mohfw.gov.in; http://icmr.nic.in. [Last accessed on 2020 Mar 28].
2.	WHO Novel Coronavirus (COVID-19) Situation. Available from: https://www.who.int. [Last accessed on 2020 Mar 28].
3.	Pradère B, Ploussard G, Catto JW, Rouprêt M, Misrai V. The use of nonsteroidal anti-inflammatory drugs in urological practice in the COVID-19 era: Is “Safe Better than Sorry”? Eur Urol 2020. pii: S0302-2838(20)30208-6. DOI: https://doi.org/10.1016/j.eururo.2020.03.033.
4.	Information for Coronavirus Disease: Urological Society of India. Available from: https://usi.org.in. [Last accessed on 2020 Mar 28].
5.	Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: Lessons learned in China and Italy. Ann Surg 2020; DOI: 10.1097/SLA.0000000000003924.
6.	Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: Is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol 2020;5:335-7.