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It is difficult to write about the crisis the world is facing at the moment without using superlatives or being too stark about the scale of the greatest-ever challenge that we all face at the moment. These are unprecedented times but it was not unpredictable, as any epidemiologist or infectious disease physician will tell you.

As the nation stands proudly behind the amazing work doctors and nurses are doing, questions are being asked about the UK’s lack of preparedness and the effect that long-term austerity has had on the NHS. From the team at Urology News we would like to express our deepest condolences to the family of Mr Abdul Mabud Chowdhury, Consultant Urologist, who sadly lost his life after having contracted COVID-19, as well as to all the other doctors, nurses and carers who have left behind loved ones. The sad irony has not been lost that Mr Chowdhury had penned a plea for personal protection equipment for frontline staff only weeks prior to his passing.



As far as is currently known, COVID-19 does not have a direct impact on the urogenital system. However, contact with a COVID-19 positive individual during the course of urological surgery exposes surgeons to the risk of infection, and the fact remains that urological emergencies will not pause because of this pandemic – stents will need to be inserted for infected obstructed kidneys and testicular torsions will need to be explored – and urgent cancer treatments will need to be carried out. Some of us will be, or have already been, re-deployed to the direct care of COVID-19 patients and need to re-learn skills long forgotten.

As described in our feature article on the impact of COVID-19 on urology, the EAU and BAUS have both provided guidance and resources on various aspects of urological care during this outbreak, such as a guide to the triage of urological surgery, management of cancer patients, and the impact on urological training. The Royal Colleges and the GMC have issued guidance as well, which is all relevant to us. The resources of the pharmaceutical and medical devices industry in helping with the management of our patients is as yet underutilised; as I discovered when I was writing my piece on GAG replenishment, it is now possible for sufferers of bladder pain syndrome to obtain supplies of intravesical treatments for self-administration via clean intermittent self-catheterisation (CISC) directly from the suppliers rather than having to attend hospital to receive treatment.

In the midst of all this, Urology News seeks to provide some degree of normality and consequently we will continue to publish informative and practical clinical information as we always have. The team has been working non-stop in spite of all the required restrictions in place to deliver this to you, and I am grateful to them for this.

The storm will surely pass, but our lives will be changed by this in many ways. Emergency situations accelerate change and innovation, and these will stay with us. The choices we make today, as a profession and as a society, will have long-term consequences and shape the way healthcare is structured and delivered in the future. I’m not just talking about the medium-term issue of having to deal with the massive backlog of semi-urgent and non-urgent cases that are now being postponed, with the same staff shortages and resource constraints that were there at the beginning of this year.

The power of honest, clear information that people can trust in changing practice and improving compliance has been demonstrated by the guidance on handwashing, and is an important social experiment that can be used to empower patients for the self-management of many different conditions in the future. The importance of sharing of information and forging collaborations between countries and teams from different disciplines is being learnt like never before: what a doctor in Milan reports today saves lives in the US tomorrow. The technology we are rapidly learning to use today for remote working will make future healthcare expertise accessible to those either in remote locations or unable to attend hospitals, where the doctor can virtually go to the patient’s bedside hundreds of miles away. It would enable a doctor from a resource-poor country to join in a virtual classroom to learn from an eminent professor in a teaching hospital. Policy decisions and healthcare spending are being decided today by clinical priorities based on clinical expertise rather than being ‘managed’: future restructuring of healthcare to a clinician-led system will enable the patient with the greatest clinical need to remain to the centre. I sincerely hope that the humility that comes with recognising that a microscopic viral particle measuring 120-160nm in diameter can bring the most powerful, richest nations of the world to a standstill in a matter of weeks will inform future political decisions on healthcare budgets. Once this is over the choices will be ours to make.

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Jay Khastgir

Princess of Wales Hospital, Bridgend & Swansea University School of Medicine.

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