key: cord-326400-yl3pisxt
authors: Bansal, Devanshu; Chaturvedi, Samit; Kumar, Anant
title: Urological Surgeries During Exit from National Lockdown During COVID-19 Pandemic
date: 2020-09-07
journal: Indian J Surg
DOI: 10.1007/s12262-020-02571-7
sha: 
doc_id: 326400
cord_uid: yl3pisxt

nan

urgent live renal transplants like lack of secure vascular access and for those not doing well on dialysis should be allowed [6] . All precautions should be taken to reduce exposure of healthy donor in hospital during investigations [7] . Prolonged prohibition on renal transplantation is likely to have a significant adverse effect on quality of life and survival of recipients. Benign urologic conditions can be divided into three categories (Table 1) , and may have significant detrimental effect on quality of life of patients. Unfortunately, this aspect of treatment has not been adequately addressed in studies.

While scheduling surgeries, a tiered system as proposed by us may be followed, so that patients who have been postponed once are able to get the required care (Table 1 ). Once planned for surgery, every patient should be screened for symptoms and tested for COVID-19. COVID-19-positive patients should be managed in a different dedicated ward and operation theatre or sent to a designated COVID-19 hospital. It should be realized that these tests have a high false negative rate (median 38% on the day of symptom onset), so a negative test should not relax use of adequate safety precautions by the doctors [8] . Duration of preoperative admission should be reduced to limit patient exposure. Informed written consent should be taken about potential risk of acquiring COVID-19 in the postoperative period before going ahead with surgery. During surgery, all internationally recommended precautions should be followed. Postoperative hospital stay should be minimized and follow-up may be done virtually. Proper medical record keeping should be ensured to avoid litigation. Absorbable skin sutures may be used wherever feasible. Drain or Foley's catheter may be removed at nearby clinic or home nursing facility to limit hospital visits.

In conclusion, routine urological surgical care may be restarted using a tiered surgical reopening plan and adequate precautions. 

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