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.