Media Release: Guidelines for Urgent Elective Urological Surgeries
25th March 2020
Urological Society issues Guidelines for selection of urgent cases as Federal Government suspends elective surgeries
The Urological Society of Australia and New Zealand (USANZ) has issued guidelines to assist urological surgeons prioritise patient cases, including those requiring treatment for prostate and other urological cancers, following the suspension of all non-urgent elective surgery in Australia by the Federal Government.
“There is a need to re-define urgent urological surgery from those procedures that relatively safely could be deferred for several months. Ventilators and anaesthetists will be in high demand to look after COVID-19 patients and as a group of ethical professionals we must at all times ensure that scarce resources are directed appropriately.
The guidelines were developed by the USANZ Board of Directors as a general guide only and shared decision making with patients is recommended where practicable.
Conditions which may require urgent surgical intervention include high risk prostate, kidney, testis, and bladder cancer as well as traumas and kidney stones.
The guidelines suggest the deferral of surgery for intermediate and some high risk prostate cancers which may instead may be safely managed with initial Androgen Deprivation Therapy and deferred definitive treatment, while immunotherapy and chemotherapy options may be considered to treat some renal or bladder cancers.
Prostate biopsies would only be performed for those patients with suspicious lesions or PIADS 4/5 detected by MRI.
Low risk prostate cancer patients on active surveillance can be followed biochemically only.
The guidelines recommend each urologist will need to base their individual decisions on their own local and personal circumstances. Each hospital may be approaching their COVID-19 strategies differently, and the advice is highly likely to vary over the coming days and weeks.
Urologists are urged to formulate a robust plan that protects their patients, junior medical staff, office and hospital staff as well as themselves with some urgency this week.
Consideration should be given whether patients acutely require investigations such as pathology and radiology or whether it may be safely deferred for a period of time.
Below is an indicative list of conditions which may warrant urgent surgical intervention during the COVID 19 crisis.
|Testis cancer:||Inguinal orchidectomy, RPLND for progressive residual mass post chemotherapy (consider deferral if suggestive of slowly growing mature teratoma)|
|Renal cancer:||Large renal cell carcinoma > 7 cm, or complicated with venous thrombus (consider immunotherapy/chemotherapy options as initial treatment in metastatic setting with secondary delayed cytoreductive nephrectomy), upper tract urothelial cancers (consider neoadjuvant chemotherapy)|
|Prostate cancer:||A proportion of high risk prostate cancers (viz., some select Gleason 8 - 10 cancers only)
Intermediate and some high-risk cancers may in many circumstances be safely managed with initial ADT and deferred definitive treatment.
Low risk cancers should be initially managed with active surveillance.
|Bladder cancer:||Cystectomy for MIBC (ideally prior neoadjuvant chemotherapy and delay surgery after discussion with medical oncology colleagues), surveillance cystoscopy +/-TURBT for high risk NMIBC only e.g., CIS and G3T1|
|Cystoscopy for macroscopic haematuria :||We recommend that a diagnostic cystoscopy should be undertaken with abnormal radiology or abnormal cytology. If these investigations are normal a delay of 1-2 months for a diagnostic cystoscopy is a low risk to the patient.|
|Prostate biopsies:||Only for suspicious prostate lesions or PIRADS 4/5 on prior MRI (not for lower PIRADS nor for protocol based AS evaluation which should be followed biochemically in 3 months)|
|TURP:||For chronic or acute urinary retention if not suitable for self-catheterisation or in dwelling IDC.|
|Endourology:||Symptomatic stones, obstructed +/- infected kidneys, stents in situ|
|Trauma:||Including penile, urethral|
+61 402 130 254
The Urological Society of Australia and New Zealand is the peak professional body for urological surgeons in Australia and New Zealand. Urologists are surgeons who treat men, women and children with problems involving the kidney, bladder, prostate and male reproductive organs. These conditions include cancer, stones, infection, incontinence, sexual dysfunction and pelvic floor problems.