Patients who have been hospitalized with Covid-19 can develop new onset urinary symptoms, according to the findings of a case series presented at the American Urological Association (AUA) 2021 Annual Meeting.

The study included 53 Covid-19 patients with severe new-onset urinary symptoms who had recently been discharged from the hospital. The control group included 12 asymptomatic subjects. The study subjects undertook an AUA Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to determine their current urinary symptoms (score of 0 to 25, increasing severity).

In both men and women with COVID-19, the average total symptom score on the AUA Urology Care Foundation Overactive Bladder (OAB) Assessment Tool was 18 (range 4-21), while the average total quality-of-life score was 19 (range 8-24). These symptoms included increase in frequency of urine, urgency, nocturia and pain or pressure upon voiding and had adversely affected quality of life. High scores on the assessment tool indicate a poor quality of life. Nocturia was the most worrying symptom. These symptoms could not be attributed to other causes such as urinary tract infection, acute renal injury, prostatitis, or urinary retention.

The study also attempted to find out any association of urinary symptoms with pro-inflammatory cytokines in the urine of patients. The urine samples were tested for SARS-CoV-2 using RT PCR, CRP by ELISA, and pro-inflammatory cytokines using Luminex assays.

While the urine samples of Covid-19 patients with urinary symptoms were negative for SARS-CoV-2, they were found to contain significantly high levels of inflammatory cytokines including growth-regulated oncogene-alpha, interleukin (IL)-6, interferon-gamma–inducible protein 10 (IP-10) and C-reactive protein (CRP).

The urinary bladder is one among the several organs affected by SARS-CoV-2 infection. Several hospitalized patients have complained of first onset of urinary symptoms post-discharge leading to significant morbidity. This study was conducted by researchers, who were the first in the US to identify severe new-onset urinary symptoms in Covid-19 patients and coin a new term “COVID-19 Associate Cystitis (CAC)” for this constellation of symptoms.

Doctors managing Covid-19 patients should be aware of the entity, COVID-19 Associate Cystitis and consider urinary symptoms occurring for the first time during the course of their illness as part of symptomatology of Covid-19. The increase in inflammatory cytokines in the urine suggests that management of such patients may require treatment with an anti-inflammatory drug to reduce and control the inflammatory response.

References

1. American Urological Association (AUA) 2021 Annual Meeting: Abstract MP29-15. Covid-19 associated cystitis (CAC): increased urinary symptoms and biomarkers of inflammation in urine in patients with acute COVID-19. Presented September 10, 2021. https://www.auajournals.org/doi/10.1097/JU.0000000000002026.15

2. New-onset bladder symptoms in discharged COVID patients - Medscape - Sep 10, 2021.