EDITORIAL COMMENT

COVID-19, Urologists and Hospitals

Amir H Kashi

*Correspondence: Urology and Nephrology Research Center (UNRC); Shahid Labbafinejad Medical Center; Shahid Beheshti 
University of Medical Sciences (SBMU), Tehran, Iran. Email: ahkashi@gmail.com.

Nowroozi et al. have presented a letter expressing concerns over the current strategy adopted by many countries including Iran to manage the COVID-19 outbreak(1). We have also faced a
similar scenario in our center which is a referral urology center in Iran. According to the policy of the Ministry of 
Health and Medical Education, all elective operations have been cancelled and all hospitals have been ordered to 
admit patients suspected for COVID-19 infection(2).
Consequently, for over a month in our center, most hospital beds have been assigned to COVID-19 patients includ-
ing most intensive care unit beds. The outlook, in case the control of outbreak spread is not successful or does not 
happen in near future, includes exhaustion of medical staff and shortage of intensive care beds leading to increased 
direct mortality of the coivd-19 disease and indirect mortality and morbidity due to shortage of available beds for 
providing medical care to other illnesses including urology treatments. Guidelines have been prepared for postpon-
ing elective operations in the era of COVID-19 infection(3) however, elective operations cannot be postponed for 
long. On the other hand, we have observed occasional cases of COVID-19 infection in patients admitted for urgent 
urological operations like Fornier gangarene who did not reveal symptoms of COVID-19 infection at presentation 
which presents the possibility of acquiring infection during hospitalization that complicates the scenario further. 
Hospitals have been declared the most important location for COVID-19 infection transmission as 45% of COV-
ID-19 infections were assumed to originate from hospitals(4). Therefore, keeping patients hospitalized in wards 
other than COVID-19 wards and caring for not contracting the COVID-19 infection is of paramount importance.
Yet, despite vast research into the COVID-19 infection in the recent months, some aspects of transmission through 
bodily fluids have not been elucidated especially in the field of urology.
The possibility of viral shedding in urine and its course and the possibility of infection transmission through this 
route which was suggested earlier for SARS infection(5) remains unanswered for COVID-19(6). Also, there are 
raising concerns in infertility laboratories working on semen samples and in some assisted reproductive techniques 
on the possibility of infection transmission through semen or sperm donation which should be further investigated.
Another interesting observation in COVID-19 pandemic is humanitarian cooperations taken place. Iran which has 
a high number of infected patients has received medical aids from many countries including Qatar, Russia, China, 
France, UK and Germany; however the country’s drug supply and medical facilities (including diagnostic kits 
for COVID-19) were in shortage even before the outbreak due to imposed sanctions by the US government and a 
universal intention to lift these inhuman sanctions is needed to avoid further suffering for Iranian patients in this 
crisis(7).

REFERENCES
 1.  Nowroozi A, Amini E. Urology practice in the time of COVID-19. Urol J. 24 March 2020 [Epub ahead 

of print].
 2.  [No authorlisted]. All Iranian hospitals ready to admit coronavirus patients. IRNA, 2020.
 3.  [No authorlisted]. https://www.auanet.org/covid-19-info-center. Accessed 23/3/2020.
 4.  [No author listed]. https://khabarfarsi.com/u/83070214. Accessed 23/3/2020 [article in Persian]
 5.  Niedrig M, Patel P, El Wahed AA, Schädler R, Yactayo S. Find the right sample: A study on the versatility 

of diagnosis of emerging viruses. BMC saliva and urine samples for the infectious diseases. 2018;18:707.
 6.  World Health Organization. Laboratory testing for coronavirus disease (COVID-19) in
  suspected human cases: Interim guidance. 19 March 2020, World Health Organization.
 7.  Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest
  sanctions against Iran. Lancet. 2020.

Urology Journal/Vol 17 No. 3/ May-June 2020/ pp. 327-327. [DOI: 10.22037/uj.v0i0.6064]