Results
A total of 51 centers from all geographical areas participated in the
study. Of these centers; 30 (58.8%) were tertiary referral centers, 15
(29.4%) were state hospitals and 6 (11.8%) were private practice
hospitals. The number of outpatients, inpatients, urological surgeries
and daily interventions were found to be dramatically decreased by the
third week of pandemics in state hospitals and tertiary referral
centers; however the daily practice were similar in private practice
hospitals throughout the pandemic period. Urooncological surgeries were
decreased week by week in tertiary referral centers; a huge decrease was
observed for the stone surgeries at the third week of the pandemics in
tertiary referral centers and state hospitals; however the number of
emergent/trauma surgeries was relatively similar in both centers during
the pandemics. The weekly analysis of workload of urology and urological
surgeries by categories were given in Figure 1 and Figure 2.
When the workload of urology in pandemic period and the same time
interval of the year 2019 were compared; a huge decrease was observed in
all variables during pandemic period (Table 1). In a detailed analysis
of the three groups of centers; a significant decrease was detected in
outpatients, inpatients, daily interventions and urological surgeries in
tertiary referral centers and state hospitals; however the decrease was
not statistically significant in private practice hospital in terms of
inpatients and daily interventions (Figure 3). The numbers of
urooncological, stone, BPH and emergent/trauma surgeries were
significantly decreased in tertiary referral centers and state hospitals
in pandemic period compared with the same time interval of the year
2019; but the numbers of urooncological and stone surgeries were similar
in private practice hospitals (Figure 4). The distributions of the
urooncological and stone surgeries in pandemic period and the same time
interval of 2019 were given in Figure 5. While the numbers of
urooncological surgeries decreased dramatically in pandemic period; the
distribution of urooncological surgeries was similar between the
pandemic period and the year 2019 (Figure 5). The highest decrease in
urooncological surgeries was detected in nephroureterectomy (338 to 25;
-92.7%); followed by radical-partial nephrectomy operations (606 to
121; -80.1%), orchiectomy (288 to 58; -79.9%), TURBT (3329 to 742;
-77.8%), radical prostatectomy (440 to 103; -76.6%), and radical
cystectomy (223 to 61; -62.7%). The number of percutaneous
nephrolithotomy and ureterorenoscopy dropped with the rates of 81.1%
(822 to 156) and 73.0% (3728 to 1010) in pandemic period. While the
total count of ureteral J stent insertion decreased as 70.4% (3279 to
972 procedures); the rate of this procedure has increased with a rate of
4% (42% to 46%) in pandemic period (Figure 5).
Although the total numbers of temporary measures like nephrostomy
placement (539 to 223; -58.7%) and percutaneous cystostomy (661 to 253;
-61.8%) for certain instances decreased; the rate of these procedures
for emergent-trauma surgeries has been found to increase during pandemic
period (15% to 22.7% and 18.4% to 25.7%; respectively).
Urologists took active role in fighting against Covid-19 with all of the
centers participating in this study; 54.4±100.7, 41.0±34.6, 10.0±24.5
pandemic outpatient clinics were performed by urologist in tertiary
referral centers, state hospitals and private practice hospitals,
respectively.