EAU COVID-19 Recommendations

EAU Guidelines Office Rapid Reaction Group:
An organisation-wide collaborative effort to adapt the EAU guidelines recommendations to the COVID era

We face a truly unprecedented healthcare crisis. The COVID 19 pandemic is testing the resources and capacity of health systems around the world. Anaesthetists and theatre teams are being redeployed, Intensive Care Units are struggling with a surge in demand and our normal working patterns are being radically altered. In addition to this, a number of frontline staff are being affected as colleagues are removed from the workforce either because of “at risk” characteristics or are themselves become exposed to the virus and are going into self-isolation after the development of symptoms. As a result, we are all being forced to reconsider the appropriate course of action for patients dealing with urological issues. This brings into question if the latest guidelines based upon the best evidence and published less than three weeks ago are relevant in this crisis.

In response to the Covid-19 pandemic, the Guidelines Office has been working in in cooperation with the Executive Committee, the Section offices and others to set up a Rapid Reaction Group (GORRG). Composed of highly experienced Board and Panel members, GORRG aims to provide rapid guidance, underpinned by the best knowledge available, on adapting EAU Guidelines recommendations to the current situation. All recommendations in the Guidelines have therefore been re-examined in-line with national and local COVID-19 guidelines and, where appropriate, adapted to the current situation. Once reassessed each new recommendation has seen rapid peer-review.

The revised recommendations cover the following areas:

• Diagnosis
• Surgical treatment
• Follow-up

In addition, each recommendation has been prioritised to allow clinicians to reflect local circumstances. Doctors will need to implement make the decision to de-escalate from a high to a lower priority or vice versa.

EMERGENCY: Cannot be postponed for more 24 hours. Life threatening situation (BLACK COLOUR).

HIGH PRIORITY: The last to cancel, prevent delay of > 6 weeks. Clinical harm (progression, metastasis, loss of organ function and deaths very likely if postponed > 6 weeks (RED COLOUR).

INTERMEDIATE PRIORITY: Cancel but reconsider in case of increase in capacity (not recommended postponing more than 3 moths: Clinical harm (progression, metastasis, loss of organ function) possible if postponed 3-4 months but unlikely) (YELLOW COLOUR).

LOW PRIORITY: Clinical harm (progression, metastasis, loss of function) very unlikely if postponed 6 months (GREEN COLOUR).

It should be understood there might not be high quality evidence for the compromises proposed but it is anticipated the new information will function as an additional guide to the management of urological conditions during the current Covid-19 (coronavirus disease 2019) pandemic, based on the current EAU Guidelines. We hope that these recommendations may also help as healthcare systems begin to emerge from the crisis and have to decide how to employ available resources.

An article has also been submitted to the Journal of European Urology giving further background and information on the revised guidelines.

Individual recommendations can be found in the archive.