Review of the COVID-19 Pandemic on the Urology Literature

Introduction: On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. Since then, our lives have changed in ways we could have never imagined. Multiple countries instituted “stay at home” quarantines, some of which continue to be in place today. The lives of healthcare workers have changed significantly, both in terms of clinical work and research. We reviewed the exisiting literature surrounding the COVID-19 pandemic to examine if there was a significant impact on the citation of recent urologic articles and the time from submission to article publication. Methods: Using the Journal Citation Reports, we reviewed the 15 urology journals with the highest impact factors in 2019 and sorted papers by whether they were related to COVID-19 or not. Articles were characterized by country of origin, type of article, subspecialty of urology, and time to publication. The Altmetric Attention Score (AAS), a metric of article dissemination, and citation count was also compared for COVID-19 versus non-COVID-19 related articles. Results: The average AAS score of COVID-19 articles was significantly higher than non-COVID-19 articles (22.5 vs 7.0, p<0.001). The highest average AAS was observed in the second quarter of 2020. COVID-19 articles had more citations than non-COVID-19 articles (7.5 vs 0.9, p<0.001). The median time between submission and publication was 52 days, compared to 164 days reported for publications in a comparable field prior to COVID-19. Conclusion: Urology articles related to COVID-19 objectively garnered more attention than articles not related to COVID-19. The publication timeline from submission to acceptance was significantly faster during the COVID-19 pandemic. of the COVID-19 Pandemic on the Urology Literature.


Introduction
The COVID-19 pandemic has changed not only our daily lives, but the very practice of medicine as we once knew it. On March 11, 2020, the World Health Organization declared COVID-19 a global pandemic. Since then, our lives have changed in ways we could have never imagined. COVID-19 has become a staple of our daily conversations with family, friends, patients, and particularly fellow colleagues in medicine. During the pandemic, the lives of healthcare workers have changed significantly, both in terms of clinical work and research. There has also been an increased interest in reviewing, studying and analyzing bibliometric trends to characterize and understand the academic literature and how it affects clinical practice [1,2]. Bibliometric instruments have been applied for analyses of the urologic literature [3,4]. Given the immense impact of the COVID-19 pandemic on medical care, investigators from many other specialties have sought to characterize the influence of the pandemic on their respective literature. Preliminary reports have documented a substantial number of peer-reviewed publications pertaining to the COVID-19 pandemic and have noted that these publications have garnered more attention compared to other articles published concomitantly [5]. Our objective in this study was to classify the effect of the COVID-19 pandemic on the urologic literature. We hypothesized that similar trends would be observed in the urological literature with articles related to the COVID-19 pandemic.

Materials and Methods
Using the Journal Citation Reports, the 15 urology journals with the highest impact factors in 2019 were identified [6,7]. These to be subsequently divided into two cohorts, those related to the COVID-19 pandemic and those not related, by searching titles for the following terms: "COVID", "SARS", "pandemic", "corona", "COVID-19", "2019 nCoV", "2019 novel coronavirus", or "SARS-CoV-2". Two hundred and sixteen (3.8%) articles met these criteria. Kruskal-Wallis tests were used to compare AAS and citations for COVID-19 versus non-COVID-19 articles. Mann-Whitney and Chi-squared tests were used to assess continuous and categorical variables, respectively. Furthermore, for articles related to COVID-19, AAS and citations were compared by type of article, sub-specialty of urology, and quarter of the year (Q) in which the article was published.

Discussion
This review and analysis indicate that the COVID-19 pandemic has had a profound impact on the urological literature. This is apparent by the number of articles published pertaining to COVID-19 during the pandemic and by the increased influence and impact these articles carried compared to non-COVID-19 related articles published concomitantly. This suggests that urologists utilized the literature as a mechanism for discussion and innovation to address the global pandemic. Early in the pandemic, research predominantly focused on the effects of COVID-19 in their respective communities and its impact on the practice of urology [9,10]. As the pandemic progressed, research became more focused, narrowing in on at-risk patient populations, such as those with renal failure infected with COVID-19 [11]. Nearly a third of all COVID-19 related articles had an AAS of zero, demonstrating that they were not disseminated at all in news outlets or social media.
Still, the mean AAS scores of COVID-19 articles were three times that of non-COVID-19 articles.
This suggests a higher level of reader interest at the time of publication for these articles and implies that research related to the pandemic was very a "hot topic." As expected, the average AAS was highest for original research articles which are typically based on higher levels of evidence with more rigorous study design, followed by guideline statements and editorial commentaries. Notably, Q2 of 2020 had the highest average AAS compared to any other single quarter of the year. A close second was Q1, followed distantly by The median time to publication for COVID-19 urology related articles was 52 days. This is markedly faster than the 164 days reported for publications of urology articles prior to COVID-19 [12]. This time acceleration may be due to an increased need for timely COVID-19-related literature to guide clinical practice during the pandemic resulting in many journals prioritizing or fast-tracking COVID-19-related articles. Additionally, the early peak of the pandemic in April and May of 2020 also coincided with the months that had the greatest number of articles published. Of the 29 total countries representing authorship, it is noteworthy that Italy had the second greatest number of publications, second only to the United States. With a population of 60 million, less than one-fifth that of the United States and substantially fewer urologists, the Italian Urologic COVID-19 publication output would be commensurate to that generated in the U.S. . Again, this may be due to a multitude of reasons, but may be attributed to increased research output secondary to the enormous COVID-19 spike Italy experienced in March 2020 [13].

Conclusion
It is clear that urology as a whole united to navigate the hurdles the pandemic created by publishing important articles in a timely fashion. From highlighting the effects of COVID-19 on male fertility, to the experience of urologists on the frontlines of the pandemic in New York City, to studying urological symptoms in COVID-19 patients, the urologic community brought its best to the COVID-19 pandemic [14][15][16]. While we patiently await our world to return to normalcy, the academic energy generated by our field during the

Financial Disclosures
None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.