Endourology and Benign Prostatic Hyperplasia in COVID-19 Pandemic

ABSTRACT The new disease COVID-19 pandemic has completely modified our lifestyle, changing our personal habits and daily activities and strongly our professional activity. Following World Health Organization (WHO) and health care authorities around the World recommendations, all elective surgeries from benign diagnose procedures must be postponed and imperatively continue working on emergent and oncological urgent pathologies. Surgical elective treatment of benign prostatic hyperplasia (BPH) is not considered as a priority. During BPH endoscopic surgeries, urine and blood are mixed with the irrigation liquid implying a risk of viral presence. Furthermore, a steam and smoke bubble is being accumulated inside the bladder implying the risk of splashing and aerosols. The risks of other viral infections have been identified during endourological procedures and they are related to splashing events. Several studies observed 33-100% of splashing on goggles. All BPH endoscopic procedures must be postponed. In case of complete urinary obstruction, this event can be adequately treated by urethral or suprapubic catheter under local anesthesia. As soon as local COVID-19 prevalence decreases, endourological procedures could be restarted. As protocols are being validating around the World to redeem elective surgeries, a symptomatic obstructed patient could be operated knowing his COVID-19 status with a molecular PCR, a cleaned epidemiological interview with a normal preoperative protocol. If patient is COVID-19+, surgery must be delayed until complete recovery, because mortality could increase as Lei from Wuhan describes. Informed consent must include risks of complications related to COVID-19 disease. Surgery must be performed by an experienced surgeon in order to avoid increase of operating time and risks of complications. Surgical approach of BPH must be considered depending on availability of disposable material, infrastructure, and the epidemiological COVID-19 status of your area. The main aim is patients and healthcare staff safety.

摘要 新型冠状病毒肺炎（COVID-19）大流行已彻底改变了我们的生活方式，重塑了个人习惯与日常活动，并对职业活动造成了显著冲击。遵循世界卫生组织（World Health Organization, WHO）及全球各国卫生主管部门的指导建议，所有良性疾病相关择期手术均应暂缓，仅可紧急开展急诊及肿瘤急症诊疗工作。良性前列腺增生（benign prostatic hyperplasia, BPH）的择期外科治疗未被纳入优先诊疗范畴。在良性前列腺增生内镜手术过程中，尿液与血液会与冲洗液混合，存在病毒暴露风险。此外，膀胱内会积聚蒸汽与烟雾气泡，进而引发体液飞溅和气溶胶形成的风险。现有研究已证实，泌尿内镜操作过程中存在其他病毒感染风险，且该风险与体液飞溅事件直接相关。多项研究显示，手术护目镜被飞溅物污染的比例可达33%至100%。因此，所有良性前列腺增生内镜手术均应暂缓实施。若患者出现完全性尿路梗阻，可通过局部麻醉下的尿道或耻骨上导管置入术进行妥善处置。待当地新型冠状病毒肺炎流行率下降后，泌尿内镜手术可逐步恢复开展。随着全球范围内用于恢复择期手术的诊疗规范不断得到验证，对于出现症状的梗阻性患者，可在完善新型冠状病毒肺炎分子聚合酶链反应（molecular PCR）检测、规范流行病学访谈及常规术前检查后实施手术。若患者新型冠状病毒肺炎检测结果为阳性，手术应推迟至其完全康复后再进行，因为正如武汉地区Lei等人所述，此类情况可能提升患者死亡率。术前知情同意书需明确告知患者与新型冠状病毒肺炎相关的并发症风险。手术应由经验丰富的外科医师主刀，以避免延长手术时长及增加并发症发生风险。良性前列腺增生的外科手术方式选择，需综合考量一次性耗材供应情况、医疗机构基础设施条件以及所在地区的新型冠状病毒肺炎流行病学状态。本次讨论的核心目标为保障患者与医护人员的安全。