The coronavirus disease 19 (COVID-19) outbreak is a current global public health problem. COVID-19 was identified in Wuhan, China in late 2019 and spread throughout the world within a few months.1 The WHO (World Health Organization) announced the COVID-19 outbreak as a pandemic on March 11 As of 2020, COVID-19 had infected more than 60 million people resulting in nearly 1.5 million deaths
Many countries declared national emergencies and closed their borders to prevent the outbreak from spreading. Governments imposed strict rules in areas of social life in many countries. Many workplaces and schools were closed, and people continued their lives at home.
COVID-19 is a new virus and there is limited data on it. All symptoms of the disease are still unknown. Diagnosing COVID-19 can sometimes be difficult due to unclear or subclinical symptoms. Patients with severe COVID-19 predominantly present with cough, fever, and other respiratory symptoms.
However, some studies have also reported serious urinary complications. COVID-19 patients, who mostly present with classic urological symptoms, should not be overlooked at present. Urinary frequency is one of the most common symptoms in urological disease. However, Mumm et al reported that urinary frequency is a common symptom in COVID-19 patients.
We observed that hospitalized COVID-19 patients suffered from lower urinary tract symptoms (LUTS). Patients have especially reported increased symptoms of dysuria after infection. Therefore, we aimed to evaluate the effect of COVID-19 on LUTS in men in this study.
What is known? COVID-19 is a new disease and many things are still unknown about it. The best-known symptoms are clear signs such as cough, fever, and respiratory infections. What’s new? Our results suggest that urinary irritative symptoms may occur regardless of the severity of COVID-19. Therefore, elderly male patients with subclinical or nonspecific symptoms should also be evaluated for COVID-19 when they present with increased lower urinary tract symptoms without apparent cause. |
Goals
The COVID-19 pandemic is the most important public health issue in 2020. Millions of people have been infected or died from the outbreak. We know the common symptoms of the disease, such as fever and cough. However, all the symptoms and characteristics of COVID-19 are still unknown.
Our objective was to evaluate the change in lower urinary tract symptoms (LUTS) after COVID-19 in men.
Methods
We prospectively evaluated 94 patients with COVID-19 during hospitalization. The patients were divided into two groups according to age, over and under 50 years of age. IPSS scores of all patients were recorded. Additionally, we compared the scores to pre-COVID-19 values.
Results
LUTS scores were found to be increased in elderly patients. Furthermore, disease severity did not correlate with LUTS scores.
Discussion
The COVID-19 outbreak is the most important disease worldwide today. Even the strong healthcare systems of many countries have faced a major crisis. Almost all doctors have worked together to overcome this crisis, regardless of the department. The daily practice of urology has changed in many countries due to the lack of sufficient numbers of doctors and hospitals, and the danger of disease spread.
Many urologists have worked in COVID-19 clinics during this period. We noticed that some COVID-19 patients suffered from dysuria and irritative urinary symptoms. To the best of our knowledge, there is limited study in the literature investigating the effect of COVID-19 on LUTS. Therefore, we prospectively designed this study and found an increase in LUTS in elderly patients with COVID-19.
The clinical symptoms of COVID-19 are mainly related to the respiratory system. The most common are fever, cough and dyspnea. Although all details are not clear, the known infectious routes in COVID-19 are nasal, nasopharyngeal, and lower respiratory tract secretions.11 There is no reliable data to support that urine is a route of transmission of the virus.
Recent studies have reported that COVID-19 is found in human and animal urine. Furthermore, Wang et al could not confirm the indication of the virus in patient urine samples. Despite these conflicting studies, urinary frequency was reported as a common symptom of COVID-19 in a recent study. Furthermore, Kaya et al reported that LUTS could be one of the initial symptoms of COVID-19.
According to our study, LUTS was found to be statistically significantly increased in elderly patients after COVID-19 infection.
This increase was not evident in younger patients. We consider that these results are related to the distribution of ACE (Angiotensin Converting Enzyme) receptors and the different age groups of the patients. COVID-19 has a strong binding affinity to ACE2 receptors. Therefore, organs with high expression of the ACE2 receptor have a higher risk of COVID-19.
Bladder urothelium is a high-risk group for viral invasion with an ACE2 expression rate of 2.4%. Viral invasion can cause endotheliitis in endothelial cells. Irritant symptoms may appear as a result of damage to the bladder mucosa. Therefore, one of the reasons for the increase in symptoms after COVID-19 may be that the urinary bladder is a high-risk group based on ACE2 expression.
We believe that the other reason for the increase in symptom scores is the age of the patients. Many studies indicated that COVID-19 infection causes more severe illness in older patients. The reason for this may be related to comorbidities and weak immune defense of elderly patients.
There are a couple of limitations to our study. First, a small number of patients were included in the study. Second, we did not evaluate viral RNA in urine samples to demonstrate COVID-19 invasion of the bladder. We use urinalysis instead of urine culture. However, cases with positive leukocytes or nitrites were excluded. Finally, patients’ stress status and mood may have affected their pre-COVID-19 IPSS scores. We don’t use a stress scale for this.
Conclusion It has been almost 8 months since the pandemic was announced and we may still be in the initial phase of the outbreak. All characteristics of COVID-19 are still uncertain. It is important to identify patients with subclinical or nonspecific symptoms to prevent or delay the spread of the virus. Symptoms of urinary irritation can occur regardless of the severity of COVID-19. Therefore, patients who have presented with LUTS should also be evaluated for COVID-19 when the reason is unclear. However, large prospective studies are needed to validate our findings. |
