Urologic research in the COVID-19 Era: Challenges and Opportunities

The Coronavirus (COVID-19) pandemic, typified as such in March 2020 by the World Health Organization (WHO), has exceeded the capacity of health systems to aid victims, and triggered a radical change in medical research, and in the monitoring of the enrollment for clinical trials in urologic fields around the world. Last year, almost 90% of clinical sites closed patient enrollment, while at the same time, researchers around the world initiated almost 1000 COVID-19 clinical trials. This catastrophic pandemic has allowed us to expand our medical knowledge exponentially. The global urological community has created and published an infinity of scientific articles: establishing guideline reactions for diagnosis, treatment, and follow-up of the different urologic conditions across all areas of the field, reporting the experiences at urology services, and putting forward new strategies. The Confederación Americana de Urología (CAU) has promoted international collaborative projects that have led to gaining insight into how the Latin American Urology Services faced the pandemic, including the challenges, strengths, and the areas of opportunity for urologic care. It also allowed us to increase the number and quality of publications. Also, we have created new virtual platforms and international networks to exchange our knowledge. We have as well transformed this social, economic and health crisis brought upon us by COVID-19, into a source of opportunities for the growth and promotion of research in Latin America. Urologic patients, require researchers to work on favoring their goals. A collaborative network, the established and coordinated protocols, the safety of patients and researchers, assertive and constant communication, and effective technology use


Resumen
La pandemia del coronavirus (COVID-19), tipificada como tal en marzo de 2020 por la Organización Mundial de la Salud (OMS), ha superado la capacidad de los sistemas de salud para ayudar a las víctimas y ha desencadenado un cambio radical en la investigación médica y en el seguimiento de los registros para ensayos clínicos en campos urológicos de todo el mundo.

Introduction
The World Health Organization (WHO) decla- are finally directed to preserve the health of patients and volunteers during the pandemic. (4)(5)(6) We aimed to review how research has been made during the COVID-19 era. Components of research (i.e., visits, informed consent, standard procedures, tests) will be discussed separately for better understanding. We will also present a summary of the development of research in Latin America during the CO-VID-19 era.

What just happened?
As mentioned earlier, the most critical issue was the lack of resources (monetary and human). All those human and monetary budgets went to aid COVID patients; as it was the needed course of action at that point. IRBs and medical organizations suspended all research activities, resulting in considerable delays in database input, document management, and sponsor meetings. (7) When the situation was difficult; and we did not know anything about the virus, the protection tools, and the interventions to achieve low morbidity and mortality rates, go- These alternative methods are not likely to be face-to-face encounters; however, we lack too much information regarding this issue. (4) Researchers need to inform the community that we are conducting trials, ensuring their protection, and fulfilling Good Clinical Practices (GCP) and the Helsinki Declaration.
This situation might be seen as an opportunity to be creative in the involvement of patients, researchers, and sponsors.
Currently, there is some evidence that the pandemic led to more good research, leaving aside some requests and inquiries that were doubtfully reasonable but required as part of the protocol. (8) In the case of the ICF, the FDA suggests the traditional paper signed copy (in cases of this being impossible, they accept electronic alternatives is necessary and, in extreme cases, if the study can go on in these particular circumstances. (4,6) As suggested by Nabhan et al., this "new normality" could represent an opportunity to improve patient follow-up, including remote tools to improve patient compliance with the trial.
Virtual visits and telemedicine require patient access to a secured virtual platform, but solving this issue would lead not only to saving time and money but to elevating patients' adherence to trials. (8) Laboratory and image studies Some essential tips to share are: (15,16) • It is possible to work at home. Get ready to do it and establish some rules to do it well. The information must be in the cloud, available for all, at any place and time, but according to data safety protocols.
• Communication with the sponsor is essential. Establish new due dates to accomplish the goals and inform of new plans.
• If it is imperative, modify the research and data analysis. This depends on the stage of the pandemic. As we previously stated: communication with the sponsor is vital.
Remember that any modification must be informed to the Institutional Review Board (IRB).
• Use different ways to collect the information: remember that we are now digital.
Nonetheless, remember that not all people are digital.
• The most crucial issue during research is to protect the research subjects. Therefore, make sure this critical topic is covered.
Also, protect researchers and collaborators.
• Train different people to work in different areas. Remember that people might get sick, but the project still needs to go on.
• Schedule frequent meetings with the team but do not overdo it. Remember the importance of mental health.