Current situation in Urology practice in Spain during the COVID-19 pandemic./ Situacion actual de la urologia en Espana durante la pandemia Covid-19

INTRODUCTION: On 11th March 2020the WHO declared COVID19 a global pandemic, a challenge previously unseen for sanitary systems, including the activity in Urology departments MATERIAL AND METHODS: Web and PubMed searchusing the keywords "SARS-CoV-2", "COVID19", "COVID Urology", "COVID surgery", "consensus methods","nominal group", "Delphi method" A narrative revision of the literature until the 20th May 2020, including articles and documents in English and Spanish ;RESULTS: Medical practice in Spain has been forced to rapidly adapt to the pandemic, dedicating most ofits material and human resources to the care of patients infected by SARS-CoV-2 This has meant a significant reduction of the routine practice in Urology, as in other medical specialities, limiting the medical attention tourgent and emergent cases Programmed activity has been reserved for selected cases in which a delayed attention could compromise survival Different scientific associations have made a significant effort to adapt their recommendations to the pandemic, prioritizing high-risk oncologic cases, and reducing the use of ventilators and hospital stays to the minimum These restrictions must be dynamic, adapting to the de-escalating phases as the pandemic is more controlled, widening the range of services available In this de-escalate there is an additional challenge, being the difficulty in generating quality scientific evidence In order to obtain such evidence, consensus methods have been used, such as the nominal group technique or the Delphi method CONCLUSIONS: The COVID19 pandemic has meant a complete disruption in the routine activity in Urologyin Spain, with a need for prioritizing the attention of urgent and high-risk oncologic pathology These restrictions must be progressively modified according to the de-escalating process in the general population INTRODUCCION: El 11 de marzo de2020 la OMS declara el estado de pandemia por COVID19, un reto sin precedentes para los sistemas sanitarios, incluyendo la actividad en el ambito de la Urologia MATERIAL Y METODOS: Busqueda web y PubMed empleando las palabras clave SARS-CoV-2, COVID19,COVID Urology, COVID surgery, consensus methods, nominal group, Delphi method Revision narrativa de la literatura hasta el 20 de mayo 2020 incluyendo articulos y documentos escritos en espanolo ingles RESULTADOS: La actividad asistencial en Espana ha debido adaptarse rapidamente a la pandemia, volcandola mayoria de sus recursos materiales y humanos para atender pacientes infectados por SARS-CoV-2 Esto hasupuesto una disminucion drastica de la actividad habitual en Urologia, al igual que en el resto de especialidades, limitando la atencion a casos urgentes y emergentes La actividad programada ha debido restringirse a sujetos muy seleccionados en los que demorar la atencion podria comprometer la supervivencia Diferentes asociaciones cientificas han realizado un esfuerzo importante para adaptar sus recomendaciones a la pandemia, priorizando patologia oncologica de mayor riesgo, y reduciendo el uso de respiradores y las estancias hospitalarias al maximo Esta restriccion debe ser dinamica, adaptandose a las fases de desescalada a medida que se vaya controlandola pandemia, ampliando los servicios ofrecidos Para esta desescalada nos enfrentamos a un reto adicional,que es la dificultad para generar evidencia cientifica decalidad que guie las actuaciones de los sanitarios Para obtener evidencia en este contexto se ha de recurrir a metodos de consenso CONCLUSIONES: La pandemia por COVID19 ha supuesto una disrupcion completa de la actividad habitual en Urologia en Espana, debiendo priorizar la atencion de patologia urgente y oncologica de riesgo Estas restricciones deben modificarse progresivamente acorde a la desescalada en la poblacion