The Coronavirus disease 2019 (COVID-19) paved the way for a large diffusion of telemedicine. Individuals followed by neuro-urology centres represent the ideal population for this service, as they are usually frail, have a long-lasting relationship with their urologists, have difficulties with travels, and present peculiar challenges, which are usually not acknowledged by general practitioners, requiring specialised care. The aim of this study was to report our telemedicine workflow and associated outcomes by a tertiary referral centre for neuro-urology.

We prospectively collected data from adult patients undergoing follow-up visits by our neuro-urology centre from May 1st to September 25th, 2020. Our staff phoned the patient to evaluate his/her feasibility to undertake this service. If they accepted, we asked patients to fill in a 10-minute-long, online, pseudonymous module. To avoid operator-dependent bias, increase coherence with patients’ real conditions and limit medicolegal issues, we included questions from international symptom questionnaires validated in Italian and for self-administration. The module collected demographic characteristics, COVID-19 signs and symptoms (S&S), pivotal urinary S&S (macrohematuria, renal colic, difficulties with catherization, urinary tract infection), urinary incontinence impact by the ICIQ-SF, and neurogenic bowel dysfunction using the MENTOR tool. The online platform was delivered as a progressive web app to avoid installation and adapt automatically to different devices. At the same time, we asked patients to send us performed exams (e.g. blood tests, medical imaging, bladder diary). After reviewing all documents, the doctors phoned the patients to discuss final indications. Later, we asked our patients to fill in an evaluation survey based on a 10-point Likert scale. This study obtained the approval by our Institutional Review Board.

In the considered period, 351 patients successfully underwent our telemedicine service. The evaluation survey highlighted most patients felt satisfied after this service (median: 10; range: 4-10). Patients were not worried about an inappropriate management via telemedicine (median: 2; range: 1-10). The online questionnaire was considered easy to fill in (median: 10; range: 3-10) and included all aspects which were worthy of evaluation according to patients (median: 9; range: 3-10). People reported they would like the continuation of this service for check-ups after COVID-19 pandemic (median: 8; range: 1-10) and they would suggest this approach to other people for follow-up (median: 9; range: 1-10). Considering first visits, most patients would not like the continuation of this telemedicine service (median: 5; range: 1-10) and would not recommend this approach to other people for first visits (median: 5; range: 1-10).

The collected results outlined a significant appreciation of our telemedicine service for check-ups by the patients followed by a tertiary referral centre for neuro-urology. In contrast, patients did not advocate telemedicine for first visits, which should be performed always in person. The core of our telemedicine approach was based on the asynchronous filling of validated international symptom questionnaires to assess appropriately and rigorously the severity of illness.

Our store-and-forward telemedicine service, based on international symptom questionnaires, proved to be really appreciated by our patients, who advocated the continuation of this service for follow-up beyond the COVID-19 pandemic.