Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic?

Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse.

To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth.

After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed.

We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good.

Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary.

The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.

European urology. 2020 Jun 18 [Epub ahead of print]

Giacomo Novara, Enrico Checcucci, Alessandro Crestani, Alberto Abrate, Francesco Esperto, Nicola Pavan, Cosimo De Nunzio, Antonio Galfano, Gianluca Giannarini, Andrea Gregori, Giovanni Liguori, Riccardo Bartoletti, Francesco Porpiglia, Roberto Mario Scarpa, Alchiede Simonato, Carlo Trombetta, Andrea Tubaro, Vincenzo Ficarra, Research Urology Network (RUN)

Department Surgery, Oncology and Gastroenterology, Urologic Unit, University of Padova, Italy. Electronic address: ., Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Italy., Urology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy., Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy., Department of Urology, Campus Biomedico University of Rome, Rome, Italy., Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy., Department of Urology, Sant'Andrea Hospital, University La Sapienza, Rome, Italy., Urology Unit, Niguarda Hospital, Milan, Italy., Urology Unit, Academic Medical Centre, "Santa Maria della Misericordia" Hospital, Udine, Italy., Urology Unit, Ospedale Sacco, Milan, Italy., Department of Translational Research and New Technologies, Urologic Unit, University of Pisa, Italy., Urology Section, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy; Urology Unit, Department of Surgery, S. Croce e Carle Hospital, Cuneo, Italy., Department of Human and Pediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Italy.

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