Figure legends
Figure 1. Week-by-week analysis of the workload of urology
during Covid-19 pandemic. Mean number values were provided for tertiary
referral centers, state hospitals and private practice hospitals. a.
Outpatient clinics; b. Inpatients during the pandemic; c. Emergency
service consultations; d. Total number of Urological Surgeries; e. All
daily interventions including intravesical administrations, prostate
biopsies, dilatations etc.; f. Weekly mean working hour of Urologists
for pandemic outpatient clinics.
Figure 2. Weekly analysis of urological surgeries by categories
a. Average case numbers for Urooncological surgery dropped to 1,8±1,4
cases from 8.5±7.8 cases by the 4th week compared to
the 1st week; b. Mean number of stone surgeries
declining by 3rd week and a plateau during the
pandemic; c. Surgery for benign prostate hyperplasia dropped to zero by
6th week for tertiary referral centers and state
hospitals ; d. Emergent-trauma surgery also declined during this
pandemic.
Figure 3. a. Average outpatient numbers significantly declined
during the Covid-19 pandemic compared with 2019 (8330.7±4727.3 to
2306.0±1330 for tertiary referral centers (p<0.001 );
6580.9±5408.3 to 1424.9±874.5 for state hospitals (p=0.001 ) and
900.3±337.2 to 427.7±303.0 for private practice hospitals
(p=0.012 )) b. Hospitalized patients in Urology clinics
significantly decreased for tertiary referral centers and state
hospitals; 508.5±402.8 to 148.3±95. (p<0.001 ) and
171.6±149.7 to 34.5±26.5 (p=0.001 ), respectively. These numbers
also decreased for private practice hospitals without statistical
significance and 98.3±28.6 to 55.0±43.7 (p=0.052 ) c. Emergency
consultations were similar between the pandemic and 2019 period for
state hospitals and private practice hospitals (74.3±61.3 to 68.0±67.1,
(p=0.721 ) and 15.3±8.9 to 9.0±13.1, (p=0.128 )) whereas
significantly decreased in tertiary referral centers (225.8±186.8 to
161.4±158.4, p=0.018 ) d. All urologic surgical activities
significantly declined compared to previous year during the pandemic
period for all centers. (591.2±815.5 to 117.2±64.4 for tertiary referral
centers (p=0.003 ); 173.2±159.0 to 32.2±27.9 for state
(p=0.001 ) and 88.3±27.9 to 48.8±35.2 for private practice
hospitals (p=0.043 )) e. Daily interventions were significantly
reduced in tertiary referral centers and state hospitals, but not for
private practice hospitals (533.6±956.2 to 108.9±210.4 , p=0.005 ;
159.1±140.1 to 41.9±38.4, p=0.007 ; and 30.7±13,0 to 21.8±13.8,p=0.292 ).
Figure 4. Comparison of certain urological surgeries between
the pandemic period and the same time interval of 2019. a. Considering
all urooncological surgical procedures, there was a decline compared to
previous year where the difference did not reach statistical
significance for tertiary referral centers and private practice
hospitals. (165.2±432.2 to 32.4±30.0, p=0.085 ; 12.2±13.2 to
3.7±2.9, p=0.022 and 14.3±11.1 to 12.8±11.3, p=0.680 for
tertiary referral centers, state hospitals and private practice
hospitals, respectively.) b. Surgery for stone disease was significantly
reduced in tertiary referral centers (210.1±181.5 to 57.5±42.4,p<0.001 ) and state hospitals (93.3±122.2 to 19.5±27.0,p=0.011 ). Case-load was similar for private practice hospitals
(21.2±2.0 to 20.3±13.2, p =0.880 ) regarding stone surgery. c. BPH
surgery decreased significantly in all hospitals. (105.7±210.1 to
26.6±21.2, p=0.038 ; 25.5±28.6 to 10.7±10.3, p=0.015 ;
6.3±3.0 to 3.3±1.7, p= 0.023; for tertiary referral centers,
state hospitals and private practice hospitals, respectively.) d.
Emergent surgical procedures also declined in all centers compared to
previous year (46.2±46.3 to 7.1±4.7, p<0.001 ; 15.0±15.9
to 1.5±1.9, p=0.002 ; 8.3±3.4 to 3.2±3.9, p= 0.011; for
tertiary referral centers, state hospitals and private practice
hospitals, respectively.)
Figure 5. The distribution of the urooncological surgeries and
stone surgeries in 2019 and during the pandemic period
a. Urooncological surgery (2019) b. Urooncological surgery (pandemic
period): The highest decrease in urooncological surgeries was detected
in nephroureterectomy (338 to 25; -92.7%); followed by radical-partial
nephrectomy operations (606 to 121; -80.1%), orchiectomy (288 to 58;
-79.9%), TURBT (3329 to 742; -77.8%), radical prostatectomy (440 to
103; -76.6%), and radical cystectomy (223 to 61; -62.7%).
c. Stone surgery (2019) d. Stone surgery (pandemic period): While the
number of ureteral J stent insertion 70.4% (3279 to 972) decreased; the
percentage of it in stone surgeries has increased with a rate of 4%
(42% to 46%) in pandemic period.