Impact of Covid 19 pandemic on tertiary care urological services - Sri Lankan experience

Introduction: Urological surgery was one of the surgical specialties with a high patient turnover during pre-COVID times. The restructuring of hospital settings has negatively impacted access to urological care. This retrospective study aimed to quantify the impact of the COVID-19 pandemic on urological services at a premier tertiary care urology unit in Sri Lanka from April 2020 to September 2021.Methods: Patient registries from Urology Unit I of the Institute of Urology and Nephrology, covering the period of April 2020 to September 2021, were audited and compared with a pre-COVID reference period of April 2018 to September 2019.Results: A total of 7,329 outpatients were seen during the pre-COVID period (407.16 patients/month), which dropped to 4,715 during the pandemic (261.94 patients/month). Inward admissions decreased from 10,958 (608.77 patients/month) to 5,460 (303.33 patients/month) during the pandemic. The number of routine urological procedures declined from 240.5 per month (n=4,329) to 119.16 per month (n=2,145). There was no significant reduction in the number of emergency urological surgeries (p=0.94). Oncological surgeries decreased from 5.2 per month (n=95) to 3.8 per month (n=69).Conclusion: The COVID-19 pandemic significantly reduced the number of patients seeking urological services. This decline may be attributed to hospital restructuring, imposed travel restrictions, and social stigma. The study emphasizes the need for more vigilant active surveillance to mitigate the reduction in early detection and follow-up of urological cancers and obstructive uropathy, in line with modified international COVID-19 guideline.