Performing Sensitive Clinical Examinations During Urological Telemedicine Visits: How to Avoid Pitfalls?

Figures & data

Table 1 Recommendations for Prioritisation of Non-Oncological Urological Procedures During the COVID-19 Pandemic as Issued by the British Association of Urological Surgeons (BAUS),^4–8 European Association of Urology (EAU),⁹ and Urological Society of Australia and New Zealand (USANZ).¹⁰ American College of Surgeons (ACS) Guidelines are Not Included as They Did Not Reference Specific Procedures

	BAUS Guidance (Stages)	EAU Guidance (Priorities)	USANZ Guidance (Urgent Interventions)
Urodynamics	1	Low	Defer
BPH surgery	1	Low	Defer
Other benign conditions (ie varicocele, hydrocele)	1	Low	Defer
Cystoscopy	1	-High (macroscopic haematuria) -Low-Intermediate (F/U without haematuria)	-Follow-up for high-risk -Diagnostic for abnormal radiology or cytology
Removal of a double-J stent	Delay if possible	Low-Intermediate (based on symptoms)	Defer
Calculi management (without infection)	−1 (elective URS and PCNL) -3 (URS with stent or ureteric calculi)	Low-High (based on symptoms)	Only if symptomatic

Notes: BAUS stages: 1 = first cancellation, 3 = last to be cancelled.

Abbreviations: F/U, follow-up; URS, ureteroscopy; PCNL, percutaneous nephrolithotomy.

Table 2 Examples of Telemedicine Approaches

Types of Telemedicine Approaches	Definition
Real-time video visits	Live video link between clinician and patient to address a clinical presentation
Store-and-forward (asynchronous transfer)	Patients share data, ie images or videos, to clinicians who review and treat outside of real-time.
Remote surveillance	Patient’s health and medical data is sent in real-time for monitoring.
Mobile health	Use of any mobile communications device as well as software applications to support healthcare.

Box 1 Summary of four key points from the GMC regarding chaperones for sensitive examination.

Point 1: For any intimate examination, regardless of means conducted, the patient must be offered the option of having an impartial observer (a chaperone) present wherever possible. This applies regardless of the clinician and the patient being of the same gender. Point 2: The chaperone should be a health professional that is: a. ‘sensitive and respect the patient’s dignity and confidentiality’. b. ‘reassures the patient if they show signs of distress or discomfort’. c. ‘familiar with the procedures involved in a routine intimate examination’. d. ‘stays for the whole examination and is able to see what the doctor is doing, if practical’. e. ‘is prepared to raise concerns if they are concerned about the doctor’s behaviour or actions’. Point 3: The patient’s relative or friend cannot act as a chaperone as they are not ‘impartial’. Point 4: The clinician should record any discussion about chaperones and the outcome in the patient’s medical record. If the patient does not want a chaperone, it should be recorded that the offer was made and declined, and the next step: i.e. if an examination at a later date was offered when a suitable chaperone available.

Notes: Data from General Medical Council. Intimate examinations and chaperones, 2013. Available from: https://www.gmc-uk.org/-/media/documents/maintaining-boundaries-intimate-examinations-and-chaperones_pdf-58835231.pdf?la=en&hash=A6DCCA363F989E0304D17FBC4ECB9C1060028385.²⁶

Figure 1 The four steps to consider prior to conducting a remote sensitive clinical examination.

NHS. Data model and dictionary; 2020. Available from: https://datadictionary.nhs.uk/nhs_business_definitions/telemedicine.html#:~:text=COMMUNICATION%20CONTACT%20METHOD.-,Telemedicine%20is%20the%20use%20of%20telecommunication%20and%20information%20technology%20for,mobile%20phones%2C%20computers%20and%20tablets. Accessed September 21, 2021.

 Google Scholar

Novara G, Checcucci E, Crestani A, et al. Telehealth in urology: a systematic review of the literature. how much can telemedicine be useful during and after the COVID-19 pandemic? Eur Urol. 2020;78(6):786–811. doi:10.1016/j.eururo.2020.06.025

 PubMed Web of Science ®Google Scholar

Amparore D, Campi R, Checcucci E, et al. Forecasting the future of urology practice: a comprehensive review of the recommendations by international and European Associations on priority procedures during the COVID-19 pandemic. Eur Urol Focus. 2020;6(5):1032–1048. doi:10.1016/j.euf.2020.05.007

 Google Scholar

Checcucci E, De Luca S, Alessio P, et al. Implementing telemedicine for the management of benign urologic conditions: a single centre experience in Italy. World J Urol. 2021;39(8):3109–3115. doi:10.1007/s00345-020-03536-x

 Web of Science ®Google Scholar

General Medical Council. Intimate examinations and chaperones; 2013. Available from: https://www.gmc-uk.org/-/media/documents/maintaining-boundaries-intimate-examinations-and-chaperones_pdf-58835231.pdf?la=en&hash=A6DCCA363F989E0304D17FBC4ECB9C1060028385. Accessed September 25, 2021.

 Google Scholar