Female LUTS adaptations to COVID era: Lessons learned from the ICS TURNOVER (Transition of fUnctional uRology to New COVID ERa)

Luis López-Fando; Paola Calleja Hermosa; Sakineh Hajebrahimi; Mauricio Plata; Bárbara Padilla Fernández; Francisco Cruz; Hashim Hashim; Salvador Arlandis

doi:10.1016/j.cont.2022.100521

Female LUTS adaptations to COVID era: Lessons learned from the ICS TURNOVER (Transition of fUnctional uRology to New COVID ERa)

Continence (Amst). 2022 Dec:4:100521. doi: 10.1016/j.cont.2022.100521. Epub 2022 Nov 17.

Authors

Luis López-Fando¹, Paola Calleja Hermosa², Sakineh Hajebrahimi³, Mauricio Plata⁴, Bárbara Padilla Fernández⁵, Francisco Cruz⁶, Hashim Hashim⁷, Salvador Arlandis⁸

Affiliations

¹ Department of Urology, Functional Urology section, Hospital La Princesa, Madrid, Spain.
² Department of Urology, University Hospital Marqués de Valdecilla, Santander, Spain.
³ Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute (JBI) Center of Excellence, Tabriz University of Medical, Tabriz, Iran.
⁴ Hospital Universitario de la Fundación Santa Fe de Bogotá, University of Los Andes, School of medicine, Colombia.
⁵ Department of Urology, Canarias University Hospital, Tenerife, Spain.
⁶ Department of Urology, Hospital São João, Porto, Portugal.
⁷ Bristol Urological Institute, Southmead Hospital, Bristol, UK.
⁸ Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain.

Abstract

Introduction: The COVID-19 pandemic has dramatically affected the Female and Functional Urology (FFU) practice, leading to massive waiting lists, while patients' quality of life remains severely impaired. The aim of the present study is to develop consensual recommendations to guide clinicians on the management of FFU patients. The present paper focuses on female LUTS.

Methods: The authors used the Delphi methodology to develop a robust survey questionnaire, covering the principal topics in FFU, based on literature review and expert opinions. Regarding female LUTS, a 98-question survey was distributed among FFU specialists to obtain optimized recommendations, under the auspicious of the International Continence Society (TURNOVER, ICS project). A quantitative analysis of the data was performed, categorizing the mean value from 0-10. Consensus achievement was defined as attaining $\geq$ 70% agreement.

Results: 98 ICS members completed the F-LUTS survey. Recommendations for the diagnosis and management of female LUTS are summarized. Video-consultation should be used for initial assessment, sending questionnaires and bladder diaries in advance to the patient to be filled out before the consultation. However, face-to-face visits are mandatory if POP or continuous incontinence are suspected, and prior to any surgical procedure, regardless of the health alert. Moreover, prescribing medications such as anticholinergics or $β$ 3 agonists in a telemedicine setting is not considered a safe practice. Follow-up teleconsultations can be used to assess the efficacy and treatment-related adverse events.Urodynamic testing should be only performed if consequences on F-LUTS treatment are expected. The study should be postponed until the pandemic local behaviour flattens.Invasive procedures should be postponed during a high alert. In case surgery is scheduled, outpatient clinics and local anaesthesia should be prioritized. Every patient should be screened for SARS-CoV-2 infection before invasive tests or procedures, following local authorities' guidance.

Conclusions: During a pandemic, telemedicine offers a novel way of communication, maintaining medical care while preventing viral transmission. Non-urgent procedures should be postponed until the pandemic curve flattens. Ambulatory procedures under regional or local anaesthesia should be prioritized, aiming to reduce bed occupancy and risk of transmission.

Keywords: BTX, botulinum toxin; CIC, clean intermittent catheterization; COVID-19; F-LUTS, female lower urinary tract symptoms; FFU, Female and Functional Urology; FTF, face-to-face; Female urology; HRQoL, health-related quality of life; LUTS, Lower urinary tract symptoms; Lower urinary tract symptoms; OV, office visits; PFMT, pelvic floor muscle training; Pandemic; SNM, sacral neuromodulation; SUI, stress urinary incontinence; Telemedicine; VV, virtual visits..