Progression of Overactive Bladder Symptoms in Patients with Prior Sars-Cov-2 Infection

INTRODUCTION AND OBJECTIVE: Infection with SARS-CoV- 2 can result in de novo or worsening genitourinary (GU) symptoms, such as frequency, urgency, nocturia, and pain/pressure, also referred to as COVID-19 associated cystitis (CAC). The aim of this study was to follow progression of OAB symptoms in patients that previously reported new or worsening OAB symptoms after COVID-19 diagnosis. METHOD(S): 19,128 individuals from a Beaumont COVID-19 serology study, were invited to participate in a follow-up study, with 2,137 subsequent respondents. Participants were divided into a COVID-, Ser+ (positive serology test only) or PCR+ (positive PCR test) groups. Initially, patients were asked to score their OAB symptoms retrospectively prior to the pandemic (baseline) and at present time (day 0). Participants were subsequently asked to score their symptoms at 2-, 4-, 8- and 12-months follow-up. Participants that obtained COVID-19 diagnosis during follow-up phase were excluded from the study. GU symptoms were assessed using the ICIQ-OAB. The minimal important difference (MID) of ICIQ-OAB of 1 is considered a significant change. Data was collected between May 2021 and July 2022. RESULT(S): Of 2,137 participants, 564 (26.4%) previously tested positive for COVID, and 1,573 (73.6%) were COVID naive (COVID-). Of these, 592 participants reported a >=1 unit increase in OAB score at study onset (Day 0) compared to pre-pandemic;243 (41%) were COVID-, 129 (21.8%) had positive serology test (Ser+), and 220 (37.2%) were COVID+ based on PCR test (PCR+). OAB score of these three cohorts were similar at pre-pandemic (2.71 vs 2.97 vs 2.53;p=0.193) but significantly higher at start of study (day 0) in PCR+ versus COVID- or Ser+ groups (5.83 vs 5.12 vs 5.33;p=0.019). In prospective follow-up, change in ICIQ-OAB scores from baseline were recorded at 2, 4, 8 and 12 months. At day 0, both Ser+ and PCR+ cohorts had significantly higher change in OAB score than COVID- group (2.8 and 3.11 vs 2.16;p=0.001). However, after 12 months follow-up, change in OAB score was similar between COVID- (1.86), Ser+ (2.15) and PCR+ (2.09). By 12 months, 74% of COVID-, 80.5% of Ser+ and 72.4% of PCR+ participants still reported significant increase in ICIQ-OAB scores from pre-pandemic levels. CONCLUSION(S): We previously demonstrated that COVID-19 infections increases the risk for developing CAC. COVID infected individuals with CAC take up to 12 months to reach levels of COVIDpatients with baseline elevated OAB Symptoms. Elevated ICIQ-OAB scores in COVID- participants may be contributed to other consequences of the pandemic such as elevated stress and depression.

A COST AND TIME ANALYSIS OF PARTICIPANT RECRUITMENT AND URINE SAMPLE COLLECTION THROUGH SOCIAL MEDIA OPTIMIZATION

INTRODUCTION AND OBJECTIVE: Clinical research study can be expensive and time consuming due to high cost and/or long duration of a study. We hypothesized that research studies using online recruitment and engaging patients via social medial channels have the potential to reach a large population in a small timeframe, at a reasonable cost. This is an especially appropriate adaptation during COVID-19, with limited hospital and clinic access. To our knowledge, no prior study has performed a detailed cost analysis of the use of online recruitment of clinical sample collection. We sought to address this knowledge gap by comparing cost and efficiency of the recruitment of urine samples online compared to recruitment of urine samples at clinical research sites. METHODS: We performed a retrospective cost analysis of a cohort study comparing cost per sample and time per sample for both online and clinically recruited participants. The retrospective review was conducted from August 2020 to September 2021. During this time, cost data was collected based on patient surveys, urine sample analyses, invoices, and budget spreadsheets. The data was subsequently subjected to statistical analysis. This study was performed with full institutional IRB approval. RESULTS: Each sample collection kit contained 3 urine cups, 1 for the IC sample and 2 for control samples. Out of the 3576 (1192 IC + 2384 control) total sample cups mailed, 1,211 (677 control) samples were returned, with a return rate of 44.8% for IC samples and 28.4% for controls. Comparatively, the two clinical sites collected 305 samples in the same period. Men and women of all age groups (18+) and ethnicities enrolled in the study, representing all 50 states. Although the initial startup cost of online recruitment was higher, cost per sample for online recruited was found to be $147.06 compared to $398.14 for clinic sample. CONCLUSIONS: We conducted a nationwide, contactless, urine sample drive through online participant recruitment, in the midst of the COVID-19 pandemic. Results were compared with the samples collected in traditional clinical setting. Online patient recruitment can be utilized to collect urine sample rapidly, efficiently and at a cost per sample that was 37% of in an in-person clinic and without risk of COVID-19 exposure.

CONDUCTING UROLOGY RESEARCH DURING COVID-19: SOCIAL MEDIA-BASED CROWDSOURCING OF URINE SAMPLES FOR BIOMARKER DEVELOPMENT

INTRODUCTION AND OBJECTIVE: Conductingresearch during the COVID-19 pandemic remains a challenge for the entireurologic community. We hereby report our effort to use social mediabasedcrowdsourcing methodology to recruit participants from the entire UnitedStates, including Alaska and Hawaii. We developed a novel research model thatcan engage multiple stakeholders and allows for fast and broad participationfor urine biomarker development towards a diagnostic tool for InterstitialCystitis (IC). METHODS: We partneredwith a patient advocacy group, the Interstitial Cystitis Association (ICA), toaid in recruitment efforts. A website with study information and links to theHIPAA-compliant enrollment questionnaire was created. The study was advertisedthough Google, and Beaumont's and ICA's social media using Twitter, emails,YouTube videos, Facebook posts, websites, and TikTok. Enrolled participants wereshipped at-home collection kits containing urine cups with preservative, a prepaidreturn mailing envelope, instructions, and survey materials. RESULTS: National publicparticipation was strong, and enrollment was closed within three months. Menand women of all age groups and ethnicities enrolled in the study, representingall 50 United States. Currently, 1,211 crowdsourced samples have been returned,including 677 asymptomatic control samples. Surprisingly, most participantsaccessed the website via mobile devices, as opposed to via desktop computer ortablet. Potential participants were referred to the website primarily by directlinks (i.e. email links), with other referring sites being Facebook, GoogleAdvertisements, the ICA's website, and Beaumont Hospital's website. CONCLUSIONS: Following COVID-19 safety guidelines, we conducted a nationwide crowdsource collection ofurine samples. Social media and web-based recruitment tools were used torecruit participants. Having a website user-friendly on mobile devices wasessential. Nontraditional recruitment methods, such as TikTok videos,encouraged study participation. Utilizing various social media platforms, it ispossible to crowdsource urine samples from across the United States quickly,economically, and most importantly during the COVID-19 pandemic, safely. (Figure Presented).