Definition |
Clinical harm very unlikely if postponed 6 months |
Clinical harm possible if postponed 3-4 months but unlikely |
Clinical harm very likely if postponed >6 weeks. |
Life-threatening situation |
COVID recommendation |
Benign scrotal and penile pathology, incontinence. |
Semiurgent cases like initial postoperative ultrasound after upper tract surgery. |
Urgent cases in which delay may cause irreversible progression or organ damage: includes ultrasound, VCUG in suspected severely obstructed uropathy where surgery is still considered. |
Continue all care in which delay is potentially organ threatening or life threatening. |
Postoperative follow -up schedule after surgery |
Priority category |
Low priority |
Intermediate priority |
High priority |
Emergency |
Definition |
Clinical harm very unlikely if postponed 6 months. |
Clinical harm possible if postponed 3-4 months but unlikely. |
Clinical harm very likely if postponed >6 weeks. |
Life-threatening situation. |
COVID recommendation |
Follow-up by 6 months |
Follow-up before end of 3 months |
Follow-up within <6 weeks. |
Follow-up within <24 hr. |
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Orchidopexy, hydrocele, hypospadias, circumcision, inguinal hernia, buried penis, urolithiasis if no obstruction or infection. |
Any kind of antireflux surgery, pyeloplasty, incontinence surgery if bladder emptying is working |
Pyeloplasty with possible loss of function. Recurrent UTI after antireflux surgery. Incontinence surgery with bladder-emptying problems. |
Macroscopic hematuria after trauma. Inguinal hernia repair with onset of scrotal pain. Suspected bowel obstruction or intestinal perforation in conjunction with bladder augmentation. Urolithiasis with signs of sepsis and/or obstruction. PUV with urinary retention. Local wound infection or abscess formation after any kind of surgery. Febrile UTI/uroseptical signs after any kind of surgery. |
Surgical procedures for pediatric urology cases |
Priority category |
Low priority |
Intermediate priority |
High priority |
Emergency |
Definition |
Clinical harm very unlikely if postponed 6 months |
Clinical harm possible if postponed 3-4 months but unlikely |
Clinical harm very likely if postponed >6 weeks |
Life-threatening situation |
COVID recommendation |
Defer by 6 months |
Treat before end of 3 months Perform surgery that is semiurgent. |
Treat within <6 weeks Perform surgery for urgent cases in which delay will cause irreversible progression of disease or organ damage. |
Treat within <24 hr. Perform surgery in cases of organ-threatening or life-threatening disease. |
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Benign scrotal and penile surgery (orchidopexy, hydrocele, inguinal hernia, circumcision).
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Functional surgery (incontinence surgery, meatotomy, botulinum toxin injections).
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Genital reconstructive surgery (hypospadias, buried penis, other genital abnormalities).
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Benign (hemi) nephrectomy.
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Bladder augmentation, catheterizable stoma, appendicocecostomy due to the high and prolonged impact on patients and resources.
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Bladder exstrophy correction depending on age and local situation.
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Surgery for VUR (open reimplant and bulk injection).
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Pyeloplasty if no loss of function.
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Urolithiasis if no infection or obstruction.
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Botulinum toxin injections for neurogenic bladder only in selected cases.
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Pyeloplasty in UPJ obstruction with progressive loss of function or severe symptoms (consider drainage with JJ of nephrostomy).
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PUV.
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POM with progressive loss of function.
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Urolithiasis with recurrent infections.
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Urosepsis with obstruction (urolithiasis, ureterocele with obstruction or POM).
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Trauma with hemodynamic instability or urinoma formation.
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PUV if urethral or suprapubic catheter cannot be placed.
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Oncology (Wilms, malignant testicular/paratesticular tumors, RMS of bladder and prostate, resection may be considered depending on local situation and condition of child).
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Acute ischemia (testicular torsion - in neonates not exploring is an option due to low chance of salvaging testis, very low risk of metachronous contralateral torsion, and increased vulnerability of these patients).
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Paraphimosis.
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General considerations
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While most children themselves may not be severely ill with COVID-19, this pandemic will impact pediatric urological care. Careful decisions must be made on what care requires postponement and what care is essential to be continued.
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Depending on the resources and capacity we recommend to only treat high-priority and emergency cases surgically during the COVID-19 pandemic.
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Consider treating intermediate-priority patients if capacity is available, but not during the COVID-19 surge.
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It is important to note that postponing surgery in patients with obstructive uropathy (UPJ, UVJ obstruction, PUV, neurogenic bladder) may lead to loss of renal function and the decision to postpone may be revised depending on the duration of the local situation as well as the severity of the obstruction in the individual case. Temporary drainage methods may be considered to bridge definitive surgery.
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Undoubtedly there will be cases of congenital abnormalities where the optimal surgical time point will be surpassed, such as hypospadias and cryptorchidism. These children may be at risk for suboptimal outcome or increased psychological burden due to delayed surgery and should be prioritized in the long waiting list.
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