We face a truly unprecedented healthcare crisis. The COVID 19 pandemic is testing the resources and capacity of health systems around the world. Anaesthetists and theatre teams are being redeployed, Intensive Care Units are struggling with a surge in demand for beds and our normal working patterns are being radically altered. In addition to this, frontline staff are being put under extreme pressure as colleagues are removed from the workforce due to “at-risk” characteristics, or are themselves become exposed to the virus and are going into self-isolation. As a result, we are all being forced to reconsider the appropriate cause of action for patients dealing with urological issues. This brings into question if the latest guidelines based upon the best evidence and published only 2 weeks ago are relevant in this crisis.
In response to the COVID-19 pandemic, the Guidelines Office has been working in cooperation with the Executive Committee, the Section offices and others to set up a Rapid Reaction Group (GORRG). Composed of highly-experienced and respected Board and Panel members, GORRG aims to provide rapid guidance, underpinned by the best knowledge available, on adapting EAU Guidelines recommendations to the current situation. All recommendations in the Guidelines have therefore been re-examined in-line with national and local COVID-19 guidelines and, where appropriate, adapted to the current situation. New evidence has been searched for by screening the available databases in a non-systematic procedure; recently accepted have been included even those still not released as provided by the publisher. One reassessed each new recommendation has seen rapid peer-review.
The revised recommendations cover the following areas:
- Surgical treatment
In each addition each recommendation has been prioritised in the following manner:
- LOW PRIORITY: Clinical harm (progression, metastasis, loss of function) very unlikely if postponed 6 months (GREEN COLOUR).
- INTERMEDIATE PRIORITY: Cancel but reconsider in case of increase in capacity (not recommended postponing more than 3 months: Clinical harm (progression, metastasis, loss of organ function) possible if postponed 3-4 months but unlikely) (YELLOW COLOUR).
- HIGH PRIORITY: The last to cancel, prevent delay of > 6 weeks. Clinical harm (progression, metastasis, loss of organ function and deaths very likely if postponed > 6 weeks (RED COLOUR).
- EMERGENCY: Cannot be postponed for more 24 hours. Life-threatening situation (BLACK COLOUR).
The Group are mindful of significant differences between countries and regions, and depending on resources, doctors will need to make the decision to de-escalate from a high to a lower priority or vice versa. It should be understood there might not be high-quality evidence for the compromises proposed but it is anticipated the new information will function as an additional guide to the management of urological conditions during the current COVID-19 (coronavirus disease 2019) pandemic, based on the current EAU Guidelines.
The revised guidelines are now been completed and can be found here on the EAU website. An article will also be published on the COVID-19 resource centre of the Journal of European Urology giving further background and information on the revised guidelines.