The impact of population lockdown on the referral pattern for urology in a COVID-19 designated tertiary hospital in Malaysia

Purpose: Once COVID-19 was first reported in Wuhan, China, in December 2019, it has rapidly spread worldwide. The Malaysian Government had taken an early measure by introducing the movement control order (MCO), which is a form of lockdown. This study aims at describing the referral pattern for urology in a COVID-19 designated tertiary hospital throughout the MCO period. Materials and Methods: All urology referrals received from March 18, 2020 to April 28, 2020 (i.e., during the MCO period) were included and assessed prospectively. For comparison, a retrospective study covering the period from February 1, 2020 to March 17, 2020 (i.e. pre-MCO period) was conducted. Parameters measured and compared include sources of referral, type of cases, outcomes, admission status, and COVID-19 status of patients referred. Results: The majority of referrals for urology were received from the emergency department during MCO (42.9%), followed by the medical ward (28.6%) and surgical ward (2.3%). In terms of the type of cases referred, during the MCO, the highest number of hematuria cases (22.5%) was received and a high number of Benign Prostate Hypertrophy (BPH) and urethral stricture cases (18.8%). Conservative measures remain the most commonly adopted outcomes/management for both pre and during MCO. The number of admissions required for urology referral showed a slight difference between pre and during MCO. Conclusion: The workload of urology referral in a COVID-19 designated tertiary hospital did not change despite MCO. This supports that the urology team still has an important role to play as a subspecialty unit in managing urology emergencies, even when elective surgeries and procedures are being reduced or rescheduled.