Endocrinology and andrology in the era of COVID-19

LETTER TO THE EDITOR

Emanuele Baldassarre 1, Antonio Ciccarelli 2, Alessandra Fraioli 3, Ilaria Prosperi Porta 4 .

1 Department of Urology and Andrology, Umberto Parini Hospital, Aosta; 2 Department of Medicine – Endocrinology Diabetology and Dietology Unit, Umberto Parini Hospital, Aosta; 3 Department of IVF, Umberto Parini Hospital, Aosta; 4 Department of Emergency Medicine, Umberto Parini Hospital, Aosta.

Dear Editor, in this particular period we faced a complete overwhelming of our routine activity and a dismantling of working life, with profound logistical changes within hospitals. We would stimulate the andrologists to a careful reflection on what is happening, reporting our experience. Unlike the endocrinological-andrologist, with an internistic background more suitable for “front-line” activity, the urological-andrologist has been catapulted into COVID-19 ward. In our Center in Northern Italy, hit hard by the pandemic, with the highest Italian incidence of confirmed cases of SARS-CoV-2 (about 850 cases / 100,000 inhabitants), all the medical doctors, included andrologists, were actively involved in new Covid wards. From the debut of March 2020, all our outpatient activities, both public and private practice, have been abruptly interrupted. Practically we had to think “more urgent things”, inventing skills and activities that we had never done before, like for example the non invasive ventilation. The time for us suddenly took on a different dimension between the shifts in Covid and the much material to study at home, continuously updated. Our goal was to guarantee to everyone a correct communication and update information. The Italian Society of Andrology (SIA) immediately recognized the need to maintain the relationships between us and organized periodic webcalls on the various andrological topics. Some surveys were also proposed for us and for patients on the quality of sexual life during the quarantine in order to optimize for the next future the data (1). The most complex aspect remains the management of patients, in a period where the outpatients, diagnostic tests and ordinary surgical activity were suspended. In particular in our region we have an outpatient dedicated to Andrology twice a week, with a space dedicated to erection rehabilitation therapies, Doppler Ultrasonography and male infertility. The personal relationship with many patients, also due to our rather small reality (about 130,000 inhabitants) and family members, however, continued through the telephone and email. I realized that the patient generally looked for a moment to exchange confidences with a trusted doctor, rather than having clarifications on a clinical problem. Very few patients have expressed to us a worsening of erectile deficit or premature ejaculation, but we noticed many cases of symptoms of suspected exacerbated prostatitis or orchiepididymitis, although in the past scientific literature the SARS-Cov was not isolated in the testicular tissue (2). We generally managed with therapies already known to the patient or with simple hygiene-dietary advice. In the pediatric andrology field, despite the low prevalence of the virus in children, our activity has completely stopped, limiting itself only to emergencies. About the world of infertility, which remained “freezed” in a sort of limbo, with many psychological strains on couples. The surgical activity at the moment has been completely stopped, with many psychological implications, especially in patients waiting for TESE (testicular sperm extraction) or microTESE and who had already undergone a hormone therapy course. Anyway, as suggested by Simoni M et al. (3) some interventions cannot be postponed also in during the limitations of COVID-19, like semen cryopreservation before cancer therapy. Beyond the ethical implications, which will be assessed over time, with the scope to give an immediate response, our Region and other private structures have offered a free psychological counseling service which has proved very useful in these cases. We realized that telemedicine could be the future in the world of IVF, also in consideration of the distances between the patient's home and the center to which they rely. In the world of infertility there is not only an email or a sharing of screenshots of blood analysis by mobile but above all there is a close relationship with a multidisciplinary team in which the visual element creates a fundamental empathy for a good final result.

Anyway It is very complex to imagine the andrological repercussions of this pandemic be and perhaps there has not been enough time to ask this to date. We believe that a gradual resumption of normal clinical activity will be increasingly integrated by the figure of the sex therapist for the individual and couples, who in a first “psychological” phase will be able to help the patient to recompose the puzzle pieces of an interrupted continuum and in a second “sexuological” phase he will be able to devote himself more specifically to the andrological disorder in itself.

References

1. Baldassarre E. An andrologist in the front line Covid-19 team. Int J Impot Res. 2020; 32(5):558-559. 2. Xu J, Qi L, Chi X, et al. Orchitis: A Complication of Severe Acute Respiratory Syndrome (SARS). Biology of reproduction. 2006; 74(2):410-416. 3. Simoni M, Hofman MC. Striving for the best: Complying with the quality criteria required by ANDROLOGY is not optional. Andrology. 2021; 9(1):5

CORRESPONDENCE Emanuele Baldassarre, MD Umberto Parini Hospital, Department of Urology and Andrology Viale Ginevra 3 11100 Aosta - Italy e-mail: ebaldas75@gmail.com Phone: +393932611979 +390165543272