LETTER

Urology practice in the time of COVID-19

Ali Nowroozi, Erfan Amini*

Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Correspondence: Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 
Email: e-amini@sina.tums.ac.ir.

COVID-19 has been suggested to behave like a “once-in-a-century pathogen we’ve been worried about”.(1) It has led to profound negative consequences in healthcare systems especially in countries with rapid spread of dis-
ease including Iran. According to World Bank data, Iran had 1.5 hospital beds per 1000 population in 2014. This is 
much lower than Italy (3.4 as of 2012) and China 4.2 (4.2 as of 2012), which both are experiencing major infection 
rates of COVID-19, alongside Iran.(2) This shortage of hospital resources will cause excess burden on Iranian health 
care providers and is expected to result in even higher infection and mortality rates over time. Healthcare workers 
are especially prone to burnout due to overstress as the Hospitals are overwhelmed by patients.
In addition to complete closure of schools and universities the government cancelled several political, social and 
religious events to tackle the rapid spread of the disease. Despite all measures, rapid escalation of COVID-19 hap-
pened partly due to delay in disease prevention and control. Therefore, almost all Hospitals were dedicated to these 
patients and modified their activities to ensure adequate number of beds for COVID-19 patients. Many surgical
departments including urology departments suspended surgeries to accommodate COVID-19 patients. This has the 
potential to postpone many time-sensitive surgeries. Currently Surgeries are limited to urological emergencies and 
almost all high volume centers have suspended timesensitive surgeries including TURBT or radical cystectomy 
for high risk bladder cancer, RPLND and nephroureterectomy as well as radical prostatectomy/radiation therapy 
for poorly differentiated prostate cancer. Moreover, fear and anxiety of COVID-19 can cause patients to avoid 
presenting in outpatient clinics and this may result in inappropriate follow up after treatment and poor outcomes in 
certain patients with urological malignancies.
It is crucial that government take steps to slow the disease spread as further escalation results in shortage in avail-
able staff and Hospital beds. Delay in disease control not only limits resources available and increases COVID-19 
mortality rate but also causes further delay in treating patients with malignant disorders including urological ma-
lignancies. The potential of communication technologies and cancer helplines should also be used for counselling 
these patients.
Healthcare workers including physicians irrespective of specialty have voluntarily participated in disease control 
and treatment and this commitment and solidarity is tremendous; however, COVID-19 medical frontliners should 
be protected as they are the most vulnerable populations.
It also should be considered that measures to control this pandemic impose a significant financial burden on health-
care and many low- and middle-income countries need economic support. Sanctions have further complicated 
the situation in Iran, and a joint effort from the global community is required to lift the extra burden from Iranian 
healthcare providers.(3)

REFERENCES
 1. Gates B. Responding to Covid-19 - A Once-in-a-Century Pandemic? The New England journal of medicine,
  2020.
 2. https://data.worldbank.org/indicator/SH.MED.BEDS.ZS.
 3. Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest sanctions against Iran.

Lancet (London, England). 2020.

Urology Journal/Vol 17 No. 3/ May-June2020/ pp. 326-326. [DOI: 10.22037/uj.v0i0.6065]