Effect of coronavirus disease 2019 on urological surgery services and training up to the peak of the pandemic in South East England

Abstract

Introduction: The coronavirus disease 2019 (COVID-19) pandemic is having significant effects on health services globally, including on urological surgery for which the British Association of Urological Surgeons (BAUS) has provided national guidance. Kent, Surrey and Sussex (KSS) is one of the regions most affected by COVID-19 in the UK to date. Methods: An anonymous online survey of all KSS urology trainees was conducted. The primary outcome was to assess the effects on urology services, both malignant and benign, across the region in the acceleration phase and at the peak of the pandemic compared to standard care. The second was to quantify the effects on urology training, especially regarding operative exposure. Results: There were significant decreases in urological services provided at the peak of the pandemic across KSS compared to standard care ( p<0.0001). Only 22% of urology units were able to continue operating for low-risk cancer and to continue cystoscopy for two-week wait non-visible haematuria referrals in line with BAUS escalation guidelines. A third (33%) did not complete any prostate biopsies at the peak. The majority of urology units continued clinics by telephone. Urology trainees reported completing substantially fewer operating procedures and workplace-based assessments. A third (33%) had moved to consultant-only operating by the peak. Conclusions: The COVID-19 pandemic has caused significant changes to urological surgery services and training in KSS, with heterogeneity across the region. We suggest further work to quantify the effects nationally. Level of evidence: 4.