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Dr. Michał Małek, MD, PhD, urologist, describes the effects of delays in the treatment of urological diseases caused by the pandemic. – Recently, for the first time in my practice, I have come across patients who reported with testicular cancer and died before starting treatment – writes a specialist in the new MedTvoiLokony cycle “Doctor’s eye”.
- Urologist alerts that the coronavirus pandemic has increased the number of severe urogenital infections
- After several months of stoppage in cancer treatment, we are starting to reap the rewards of this situation and we will collect them for the next year – writes Dr. Małek
- The doctor appeals to men: do not ignore any symptoms and visit urologists
- You can find more such stories on the TvoiLokony home page
The impact of a pandemic on the treatment of urological diseases
The coronavirus pandemic has completely changed the way urological care functions in Poland. Many urological departments have been converted into covid units, limiting the possibility of treating urological diseases only to emergency cases. Most urology clinics had to drastically limit access to specialists, most often providing care in the form of telepaths. Unfortunately, such a situation may persist for several more months, and the return to normal functioning of urology is difficult to predict.
Being an actively practicing urologist, I can clearly see the effects of the above events. There is a noticeable increase in the incidence of severe infectious diseases of the genitourinary system. Significantly more patients report with extensive scrotal and testicular abscesses or scrotal phlegmon. I also encounter numerous cases of extensive perirenal abscesses or advanced pyonephrosis, which was previously a relatively rare condition. It is related to the lack of urological treatment in the early stages of infection. Patients also have limited access to diabetologists – this results in the disorder of diabetes, which results in severe urological infections. Many patients also develop infections due to untreated nephrolithiasis or ureteral stones because they cannot see a specialist. It is to be expected that we will have to deal with such patients frequently this year.
Pandemic caused a “rash” of cancer?
A growing problem is also the progression of neoplastic changes in the bladder and lower urinary tract. Due to the difficult access to a urologist, patients do not seek help after the first episodes of hematuria, but only at the time of severe anemia or massive bladder tamponade. Many such patients already have unresectable or deeply infiltrating changes, which makes organ-saving treatment impossible and results in the necessity of destructive radical or, as a last resort, palliative treatment. I would like to emphasize that haematuria is an extremely important and alarming symptom that cannot be ignored and requires diagnostics by a urologist.
After a few months of downtime in the treatment of cancers of the genitourinary system, we are starting to reap the rewards of this situation and we will do so for the next year. Patients who have had deferred treatment begin to reappear, but with significant tumor progression. This is especially true in patients with kidney tumors or invasive bladder cancer. I am sorry to say that I have noticed cases of the development of the disease to a degree that makes surgical intervention impossible. These are very unpleasant situations for me as a doctor, but simply dramatic for my patients.
I also encounter cases of very advanced testicular tumors, which I have never found before. Men who are ashamed of visiting a doctor on a daily basis due to a genital ailment now have additional difficult access to it. This results in a significant delay in the diagnosis and treatment of testicular cancer. I would like to emphasize that testicular cancer is one of the few cancers that responds perfectly to treatment and that its curability is very high. The condition for this is relatively early treatment. Recently, for the first time in my practice, I have come across patients who presented with obstruction or severe cancer cachexia in the course of testicular cancer and died before starting treatment.
All I can do is appeal to men not to underestimate the changes they sense in their testicles and find a way to visit a urologist, because they can win something most important, i.e. their own life.
It is optimistic that, despite the raging pandemic, robotics is constantly developing in Polish urology. As a robotic operator, I have the opportunity to observe the enormous benefits of using a robot. I would like myself, especially patients, to further develop this branch of urology in the coming year. The fruits of medical advances should be harnessed.
The next year will be hard work. The medical staff, especially doctors, will have to put in an effort to catch up with the treatment of the sick. I also appeal to patients for commitment and fight for their own health. We must unite in the effort to achieve this common goal.
Head of the operating suite at the Mazovia Hospital. He is certified as a da Vinci surgical robot operator. He graduated from the Medical University of Warsaw, worked at the Urology and Urology Oncology Clinic of the Central Clinical Hospital of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, at the Urology Department of the Międzyleski Specialist Hospital in Warsaw and at the Urology Department of the Provincial Hospital in Legnica. He is also a visiting operator at the Radom Cancer Center and at the St. Wojciech in Gdańsk.
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