The
coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including
surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the
COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. Patients with advanced age and comorbidities have a higher incidence of mortality. Routine preoperative testing and symptom screening is recommended to identify those with
COVID-19. Adequate
personal protective equipment (PPE) for the surgical team is essential to protect health care workers and ensure an adequate workforce. For
COVID-19 positive or suspected patients, the use of
N95 respirators is recommended if available. The
anesthesia method chosen should attempt to minimize aerosolization of the virus.
Negative pressure rooms are strongly preferred for intubation/extubation and other aerosolizing procedures for
COVID-19 positive patients or when COVID status is unknown. Although transmission has not yet been shown during laparoscopic and robotic procedures, efforts should be made to minimize the risk of aerosolization. Ultra-low particulate air filters are recommended for use during minimally invasive procedures to decrease the risk of viral transmission. Thorough cleaning and sterilization should be performed postoperatively with adequate time allowed for the operating room air to be cycled after procedures.
COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of
infection. Future directions will be guided by outcomes and
infection rates as social distancing guidelines are relaxed and more
surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a
vaccine and
therapeutics for
COVID-19 are developed.