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.