COVID-19 Associated With Increased Risk of New Genitourinary Symptoms, Inflammatory Markers in Urine

Patients with coronavirus disease 2019 (COVID-19) and COVID-19-associated cystitis (CAC) reported increased rates of new genitourinary symptoms, including increased urinary urgency frequency, and these patients also show signs of augmented pro-inflammatory cytokines in their urine, according to a study presented by Michael Chancellor, MD, of Beaumont Health in Royal Oak, Michigan, at the 2021 American Urological Association Annual Meeting.

Comorbidities significantly increase the risk of COVID-19-related morbidity and mortality and also increase the risk of organ-specific complications. As the COVID-19 pandemic evolved and more data became available on the effect of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on comorbidities, researchers began to see the bladder as a critical target for the novel virus.

According to Dr. Chancellor, he and his research team were the first in the United States to find that patients with COVID-19 were experiencing severe de novo genitourinary symptoms, potentially implicating SARS-CoV-2 infection in bladder function and outcomes. In the most recent study, Dr. Chancellor and colleagues examined urine samples of 53 discharged patients with COVID-19 (median age, 64.5 years) and normal renal function, and 12 asymptomatic controls.

Study investigators tested the urine for COVID-19 using PCR in addition to C-reactive protein (CRP) and pro-inflammatory cytokines. Participants completed an overactive bladder (OAB) assessment tool that quantified their current urinary symptoms on a score from 0 to 25, with increasing scores representing corresponding increases in symptom severity.

In both men and women with COVID-19, the median total OAB symptom score was 18 and ranged between 4 and 21. Additionally, the median quality of life (QoL) score for all patients was 19 and ranged from as low as 8 to as high as 24.

Common symptoms reported in patients with CAC included increased urinary frequency, urgency, nocturia, as well as pain or pressure upon voiding. The researchers noted that the symptoms were not caused by acute renal injury, urinary retention, urinary tract infection, or prostatitis.

In patients with CAC, the de novo genitourinary symptoms led to worsening QoL, with nocturia representing the most bothersome symptom. Most patients with COVID-19 did not show signs of the virus in their urine. Compared with non-COVID-19 healthy controls, patients with COVID-19 had significantly increased levels of growth-regulated oncogene/CXCL-1, interleukin (IL)-6, Interferon gamma-induced protein 10, and CRP in their urine samples.

While the findings demonstrate COVID-19 may be associated with increased pro-inflammatory cytokines in the urine, the implications of these findings were not explored in the study.