We aim to assess the risk of infection during urologic surgeries. Therefore possible hazards in tissue, blood, urine and aerosolized particles generated during surgery, are evaluated. Understanding the risk, recommendations for clinical practice are provided.
Review of available literature on urological and other surgical procedures in patients with virus infections such as HPV, HIV and hepatitis B and current publications on COVID-19.
Several possible pathways for viral transmission appear in the literature. Recent groups detected SARS-CoV-2 in the urine and faeces, even after negative pharyngeal swabs. In addition, viral RNA can be detected in the blood and several tissues. During surgery, viral particles are released, aerosole-borne and present a certain risk for transmission and infection. However, there is currently no evidence on the exact risk for infection by the substances mentioned above. It remains unclear whether or not viral particles in the urine, blood or faeces are infectious.
Whether SARS-CoV-2 can be transmitted by aerosols remains controversial. In any case, standard surgical masks offer inadequate protection from SARS-CoV-2. Full PPE including at least FFP-2 masks and safety goggles should be used. Aerosolized particles might remain for a longer time in the operation theatre and contaminate other surfaces, like floors or computer input devices. Therefore scrupulous hygiene and disinfection of surfaces must be carried out. To prevent aerosolization during laparoscopic interventions, the pneumoperitoneum should be evacuated with suction devices. The use of virus proof HEPA filters is recommended. Local separation of anesthesia/intubation and operation theatre can reduce the danger of viral transmission. Lumbar anaesthesia should be considered especially in endourology. Based on current knowledge, COVID-19 is no contraindication for acute urological surgery. If possible however, as european guideline committees recommend, non-emergency urological interventions should be postponed until negative SARS-CoV-2 tests become available.
BJU international. 2020 Jun 19 [Epub ahead of print]
Yannic Kunz, Wolfgang Horninger, Germar-M Pinggera
Medical University Innsbruck, Department of Urology, Anichstrasse 35, 6020, Innsbruck, Austria.