Table 1 Urgency classification for triaging of urologic conditions and surgeries
From: Methodology for triage of urologic surgical cases in the setting of a pandemic
Class | Subclass | Condition | Surgery | Classification rationale |
|---|---|---|---|---|
3 | 3c | Bladder cancer (CIS or high-grade UC i.e. MIBC or recurrent or persistent NMIBC) | Radical cystectomy | Delays in cystectomy are adversely related to survival outcomes. |
TURBT for suspected bladder cancer | Early diagnosis and treatment are essential to optimize outcomes. | |||
High-grade UTUC | Nephroureterectomy | Delays in surgery are associated with adverse outcomes. | ||
Ureteroscopy and biopsy if suspected | Early diagnosis and prompt subsequent management is essential for optimal outcomes. | |||
Kidney cancer (organ confined T3+ , tumors with renal vein or IVC thrombus, tumors > 10 cm) | Radical nephrectomy +/− tumor thrombectomy | High risk of early spread and adverse outcomes. | ||
Testicular cancer | Radical orchiectomy | Limited survival data but concerns for early metastasis. | ||
Adrenal tumors; > 6 cm | Adrenalectomy | High risk for being cancerous and subsequent early spread. | ||
Penile cancer | Total or partial penectomy | Limited data but early surgery may prevent lymphatic spread. | ||
3b | Kidney cancer | Radical Nephrectomy for renal tumors 7–10 cm | High risk for growth and metastasis. | |
Partial nephrectomy for T2 renal tumors/tumors in a solitary kidney | Large renal tumors may grow too large for a possible partial nephrectomy if delayed. | |||
3a | Prostate cancer (high-risk) | Radical prostatectomy if organ confined | Potential increased risk in BCR and adverse outcomes with delays in management. | |
Kidney cancer | Radical or partial nephrectomy for T1b renal tumors | Risk of cancer extension and metastasis. Growth of tumors during a delay may prevent possible a partial nephrectomy. | ||
Obstructing symptomatic nephrolithiasis; non-stented or with stent > 6 months | Ureteroscopy PCNL | Risk of permanent renal damage with long-term obstruction, pyelonephritis, and severe encrustation with stents > 6 months. | ||
2 | 2b | Bladder cancer (low-grade UC) | TURBT for bladder recurrences of known low grade UC | Low-grade UC is slow growing with non-aggressive features. Delays can be several months without potentially affecting outcomes. |
PCa (unfavorable, intermediate risk) | Radical prostatectomy | Potential increased risk in BCR and adverse outcomes with delays in management. | ||
Testicular cancer | Primary or post-chemotherapy RPLND | Limited data regarding the effect of delayed surgery. | ||
2a | Kidney cancer | Partial nephrectomy for T1a renal tumors | Low risk of progression and metastasis. | |
PCa (favorable, intermediate risk) | Radical prostatectomy | Low risk of spread and progression. | ||
Complicated BPH | TURP Simple prostatectomy | Risk of the condition worsening with severe infection or bleeding. | ||
1 | Miscellaneous Urethral stricture Incontinence req. AUS Erectile dysfunction | Reconstructive surgery Urethroplasty Ureteral re-implant AUS IPP | Condition can be stabilized by drainage (Foley, SPT, or PCN); quality of life conditions with no medical urgency. | |
Female urology, incontinence Pelvic prolapse | Urethral diverticulectomy Sacrocolpopexy Prolapse repair, etc. | Quality of life conditions with no medical urgency. | ||
Infertility | Microsurgical Recon. Sperm extraction | |||
Non-complicated BPH | TURP Simple prostatectomy | |||
Non-complicated nephrolithiasis | Ureteroscopy/PCNL | |||