Introduction and hypothesis: The COVID-19 pandemic and the desire to "flatten the curve" of transmission have significantly affected the way providers care for patients. Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) must provide high quality of care through remote access such as telemedicine. No clear guidelines exist on the use of telemedicine in FPMRS. Using expedited literature review methodology, we provide guidance regarding management of common outpatient urogynecology scenarios during the pandemic.
Methods: We grouped FPMRS conditions into those in which virtual management differs from direct in-person visits and conditions in which treatment would emphasize behavioral and conservative counseling but not deviate from current management paradigms. We conducted expedited literature review on four topics (telemedicine in FPMRS, pessary management, urinary tract infections, urinary retention) and addressed four other topics (urinary incontinence, prolapse, fecal incontinence, defecatory dysfunction) based on existing systematic reviews and guidelines. We further compiled expert consensus regarding management of FPMRS patients in the virtual setting, scenarios when in-person visits are necessary, symptoms that should alert providers, and specific considerations for FPMRS patients with suspected or confirmed COVID-19.
Results: Behavioral, medical, and conservative management will be valuable as first-line virtual treatments. Certain situations will require different treatments in the virtual setting while others will require an in-person visit despite the risks of COVID-19 transmission.
Conclusions: We have presented guidance for treating FPMRS conditions via telemedicine based on rapid literature review and expert consensus and presented it in a format that can be actively referenced.
Keywords: COVID-19; FPMRS; Pandemic; Systematic review; Telemedicine; Urogynecology; Virtual visit.
Conflict of interest statement
Grimes: Expert testimony for Johnson and Johnson.
Meriwether: Consultant for RBI medical, Travel reimbursements from SGS (voting board member as Research Chair), Book editing/authorship royalties from Elsevier.
Jeppson: Consultant for Johnson & Johnson.
Balk: Consultant for society for Gynecologic Surgeons and American Association of Gynecologic Laparoscopists.
Murphy: Expert witness for Johnson and Johnson, Boston Scientific, President of Soceity of Gynecologic Surgeons.
No conflicts: Balk, Crisp, Antosh, Adam, Weber LeBrun, Halder, Kim-Fine, Dieter, Raman, Yurteri-Kaplan, Iglesia.
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