key: cord-0722816-dnosl6ru
authors: Chan, Ming-Chun; Yeo, Sharon E.K.; Chong, Yew-Lam; Lee, Yee-Mun
title: Reply to Guglielmo Mantica, Nazareno Suardi, and Carlo Terrone’s Letter to the Editor re: Ming-Chun Chan, Sharon E.K. Yeo, Yew-Lam Chong, Yee-Mun Lee. Stepping Forward: Urologists’ Efforts During the COVID-19 Outbreak in Singapore. Eur Urol. In press. https://doi.org/10.1016/j.eururo.2020.03.004
date: 2020-05-08
journal: Eur Urol
DOI: 10.1016/j.eururo.2020.04.071
sha: c8af61e5b0b1622d1f1864d366cd7f11fbc9e96a
doc_id: 722816
cord_uid: dnosl6ru

nan

The insightful letter from Mantica et al in response to our article [1] reports a trend for a decrease in emergency department (ED) urological consultations in Italy during the COVID-19 lockdown and highlights two major issues for urologists. First, postponement of urological consultations carries a risk of potential rebound attendances in worsened condition and larger numbers. Our hospital implemented measures in anticipation of this, reviewing and triaging [2, 3] all scheduled appointments and adopting telemedicine strategies including phone consultations and prescriptions (with courier delivery), a huge endeavour given the sheer volume of ambulatory patients. Second, the pandemic-related decrease in ED consultations is a reminder of the delicate balance in managing urological conditions in the community and tertiary settings. The second issue brought to the surface by this pandemic of possible chronic abuse of hospital resources by low-complexity cases is a sensitive one. A review of our data set revealed that the decrease in urolithiasis consultations reported by Mantica et al is similar to our reduction in urolithiasis admissions. We postulate that during the COVID-19 pandemic, Singapore patients were preferentially seeking conservative care in the community or deferring consultations. This is in contrast to the higher percentage of haematuria cases noted by Mantica et al, similar to the higher percentage of genitourinary infections we observed, as these conditions can seldom be deferred. Importantly, we must further analyse if this percentage rise in infections and haematuria is a consequence of delayed health-seeking behaviour or of failed treatment in the community. Our data set is unable to definitively determine if ED abuse was the case, but with rigorous admission criteria we can prevent unnecessary admissions and preserve inpatient resources.

COVID-19 will have a long-lasting impact on health care and urological practice will be no exception. These observations remind urologists of the importance of our nations' health care policies to establish an integrated system of primary, emergency, and tertiary care so that patients can access essential care in the community, even during crises. If urologists act quickly in anticipating post-COVID-19 issues and in using this pandemic to review reforms for our health care systems, we can emerge stronger than before.

The authors have nothing to disclose.

J o u r n a l P r e -p r o o f

Stepping forward: urologists' efforts during the COVID-19 outbreak in Singapore

Considerations in the triage of urologic surgeries during the COVID-19 pandemic

Endourological stone management in the era of the COVID-19

Ministry of Health Singapore. Circuit breaker to minimise further spread of COVID-19

Government of Singapore. What do the different DORSCON levels mean