The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.

Academic Urology Unit University of Aberdeen Aberdeen UK

Alta Uro AG Merian Iselin Klinik Center of Biomechanics and Calorimetry University Basel Basel Switzerland

Department of Female Functional and Restorative Urology University College London Hospitals NHS Foundation Trust London UK

Department of Oncology Unit of Urology Urological Research Institute IRCCS Ospedale San Raffaele Milan Italy

Department of Paediatric Urology Leeds Teaching Hospitals NHS Trust Leeds UK

Department of Surgical and Perioperative Sciences Urology and Andrology Umeå University Umeå Sweden

Department of Urology 2nd Faculty of Medicine Hospital Motol Charles University Prague Czech Republic; Department of Urology Medical University of Vienna Vienna Austria

Department of Urology and Transplant Guy's and St Thomas' NHS Trust Hospitals London UK

Department of Urology Cantonal Hospital St Gallen Switzerland

Department of Urology Erasmus MC Rotterdam The Netherlands

Department of Urology Ghent University Hospital Ghent Belgium

Department of Urology Herlev and Gentofte University Hospital Herlev Denmark; Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Department of Urology Hospital of the Sisters of Charity Vienna Austria; Urologische Praxis mit Steinzentrum Vienna Austria

Department of Urology Medical Faculty Carl Gustav Carus Technical University of Dresden Dresden Germany

Department of Urology Medical School University of Ioannina University Campus Ioannina Greece

Department of Urology Medical University of Innsbruck Innsbruck Austria

Department of Urology Medipol Mega Istanbul Medipol University Istanbul Turkey; Amsterdam UMC Amsterdam The Netherlands

Department of Urology Onze Lieve Vrouw Hospital Aalst Belgium; ORSI Academy Melle Belgium

Department of Urology Ospedale San Raffaele Turro Milan Italy

Department of Urology Radboud University Medical Center Nijmegen The Netherlands

Department of Urology Sheba Medical Centre Tel Hashomer Israel

Department of Urology Sheffield Teaching Hospitals NHS Trust Sheffield UK

Department of Urology Sindelfingen Böblingen Medical Centre University of Tübingen Sindelfingen Germany

Department of Urology SLK Kliniken Heilbronn University of Heidelberg Heilbronn Germany

Department of Urology The 1st Affiliated Hospital School of Medicine Zhejiang University Hangzhou Zhejiang Province China

Department of Urology University Hospital of Larissa Larissa Greece

Department of Urology University Hospital St Etienne France

Department of Urology University Hospital Tuebingen Tuebingen Germany

Department of Urology University Hospitals Leuven Leuven Belgium

Department of Urology University of Modena and Reggio Emilia Modena Italy

European Association of Urology Guidelines Office Arnhem The Netherlands

Klinik und Poliklinik für Urologie Universitätsmedizin Rostock Rostock Germany

Liverpool University Hospitals Foundation NHS Trust Liverpool UK

NHS Foundation Trust St George's University Hospitals London UK

Oncology Urology Unit Department of Urology Fundació Puigvert Universitat Autònoma de Barcelona Barcelona Spain

The Royal Free London NHS Foundation Trust and UCL Division of Surgery and Interventional Science London UK; Department of Urology The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam The Netherlands

Uro Oncology Unit Hospital Clinic University of Barcelona Barcelona Spain

Urology Department Freeman Hospital Newcastle upon Tyne UK

Urology Department University of Patras Patras Greece

Urology Sorbonne University GRC 5 Predictive onco uro AP HP Pitie Salpetriere Hospital Paris France

Urology Unit Academic Medical Centre Hospital Santa Maria della Misericordia Udine Italy

Comment In

Eur Urol Focus. 2020 Sep 15;6(5):1135-1136. doi: 10.1016/j.euf.2020.05.018. PubMed

Comment In

Eur Urol. 2021 Mar;79(3):427. doi: 10.1016/j.eururo.2020.11.030. PubMed

See more in PubMed

Worldometer COVID-19 data. https://www.worldometers.info/coronavirus/2020.

European Association of Urology . 2020 edition. European Association of Urology Guidelines Office; Arnhem, The Netherlands: 2020. European Association of Urology guidelines.

Ficarra V, Novara G, Abrate A, et al. Urology practice during COVID-19 pandemic. Minerva Urol Nefrol. In press. 10.23736/S0393-2249.20.03846-1. PubMed DOI

John T. CNN; 2020. Iceland lab’s testing suggests 50% of coronavirus cases have no symptoms. https://edition.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-intl/index.html

Day M. Covid-19: four fifths of cases are asymptomatic, China figures indicate. BMJ. 2020;369:m1375. PubMed

Lei S, Jiangb F, Sua W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. In press. 10.1016/j.eclinm.2020.100331. PubMed DOI PMC

Mottrie A., Puliatti S., Mazzone E. ERUS; 2020. ERUS-EAU Robotic Urology Section ERUS (EAU Robotic Urology Section) guidelines during COVID-19 emergency. EAU Robotic Urology Section. https://uroweb.org/wp-content/uploads/ERUS-guidelines-for-COVID-def.pdf

Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg. In press. 10.1097/SLA.0000000000003924. PubMed DOI PMC

Li C.I., Pai J.Y., Chen C.H. Characterization of smoke generated during the use of surgical knife in laparotomy surgeries. J Air Waste Manag Assoc. 2020;70:324–332. PubMed

WHO World Health Organization; 2020. Laboratory testing for coronavirus disease 2019 (COVID-19) in suspected human cases: interim guidance, 2 March 2020. https://apps.who.int/iris/handle/10665/331329

Ling Y, Xu SB, Lin YX, et al. Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med J. In press. 10.1097/CM9.0000000000000774. PubMed DOI PMC

WHO World Health Organization; 2020. Laboratory biosafety guidance related to coronavirus disease 2019 (COVID-19) interim guidance, 12 February 2020. https://apps.who.int/iris/handle/10665/331138

Yeo C., Kaushal S., Yeo D. Enteric involvement of coronaviruses: is faecal-oral transmission of SARS-CoV-2 possible? Lancet Gastroenterol Hepatol. 2020;5:335–337. PubMed PMC

Ohannessian R., Duong T.A., Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action. JMIR Public Health Surveil. 2020;6 PubMed PMC

Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med. In press. 10.1056/NEJMp2003539. PubMed DOI

SAGES. SAGES and EAES recommendations regarding surgical response to COVID-19 crisis. https://www.sages.org/recommendations-surgical-response-covid-19/2020.

Brücher B.L.D.M. COVID-19: pandemic surgery guidance. 4open. 2020;3:1.

WHO World Health Organization; 2020. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance, 19 March 2020. https://apps.who.int/iris/handle/10665/331498

Organisations IC . ICM Anaesthesia COVID-19. 2020. Information, guidance and resources supporting the understanding and management of coronavirus (COVID-19)https://icmanaesthesiacovid-19.org/

Ti L.K., Ang L.S., Foong T.W., Ng B.S.W. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth. 2020:1–3. PubMed PMC

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A systematic review and meta-analysis on delaying surgery for urothelial carcinoma of bladder and upper tract urothelial carcinoma: Implications for the COVID19 pandemic and beyond

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Oncologic impact of delaying radical prostatectomy in men with intermediate- and high-risk prostate cancer: a systematic review

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