The word unprecedented has been used a lot over the last 9 months, but to be in a position where we had to stop or delay the majority of our NHS cancer surgery for a few months is something we have never seen before and will be unlikely to see again in our careers.
In March, within Urology we had to rapidly re-organise our services and as EKHUFT cancer lead and Prostate Cancer lead for the Kent and Medway Alliance, we had to decide which cancers were time sensitive and which could wait, not an easy task and particularly hard for our patients having been recently diagnosed or on our waiting lists that had to be told we would be postponing their treatments. Initially there was little guidance but within weeks the British Association of Urological Surgeons and European Association of Urology produced valuable advice; however policies changed rapidly and were geographically dependent upon COVID prevalence.
The crux of all the policies were to keep patients out of hospital unless absolutely essential, coupled with that, early emerging data coming out of Wuhan showed up to 20% mortality if COVID was contracted in the post-operative period. Subsequent data from a large international trial out of the Birmingham surgical trials unit seemed to also suggest similar mortality rates. Patients undergoing major surgery were certainly at risk if not dealt with within a “clean” environment.
As a result only time sensitive cancers were operated on. Urothelial and testicular cancers were regarded as higher risk therefore most TURBT’s and Cystectomy’s continued although with the absence of neoadjuvant chemotherapy. Most small renal tumours and all prostate cancers were not regarded as time dependent and surgery was delayed. Patients with high risk prostate cancer were managed with neoadjuvant hormonal therapy until we were able to start up the robotic service again in July. Our pathways were rapidly changed to virtual clinics where appropriate and diagnostic clinics altered. We had previously set up a local anaesthetic perineal prostate service and we moved entirely to this to reduce sepsis rates and hospital admissions from TRUS biopsy.
Due to lower footfall, smaller hospitals, separate rooms and more stringent infection control policies, the independent sector was able to open earlier and started to see patients face-to-face, albeit with very tight infection control practices that remain in place.
One Ashford Hospital has been managing a highly effective COVID strategy and patients are being seen within a very safe and controlled environment. As a result we are able to run a full service for both benign and malignant Urological conditions. We are able to see and assess patients with safe social distancing, and we are able to offer full Urological cancer diagnostics safely, including flexible cystoscopy’s, MRI imaging and perineal prostate biopsies. Essentially our Urological service is open for business with rapid face-to-face or virtual appointments, along with rapid diagnostics and treatment.
COVID has been difficult for patients and clinicians alike but we feel we are able to provide a safe service to all our patients until the end of this pandemic.
Mr Ben Eddy FRCS(Urol)
Consultant Urological Surgeon
Mr Ben Eddy is a Consultant Urological Surgeon based at One Ashford Hospital. He has a particular interest in men’s health and at the hospital he has set up a Rapid Access pathway for patients with suspected prostate cancer and raised PSA’s. He is very experienced in advanced diagnostics including the use of pre biopsy MRI since 2014, Multi Parametric MRI and perineal fusion biopsy techniques.
To learn more on Mr Eddy, please click here