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INTRODUCTION AND OBJECTIVE: COVID-19 associated cystitis (CAC) is a newly-described condition associated with new onset or exacerbations of baseline urinary symptoms (e.g. overactive bladder (OAB) symptoms) that may present as a manifestation of Long COVID. Little is known on the management and long-term outcomes for patients suspected of having CAC. In this study we aim to assess the long term efficacy of conservative OAB the on their symptoms. METHOD(S): In this prospective cohort study, we identified patients with CAC 10-14 weeks following discharge from 2 academic downtown Detroit hospitals with new or worsening OAB during 5/22/ 2020 to 12/31/2020. Symptoms were assessed at baseline and at 21- 28 months post-discharge using the AUA's 5 symptom OAB assessment tool and 4 quality-of-life (QoL) symptoms, based on gender and changes in urinary symptom status. RESULT(S): A total of 350 patients with CAC were identified, of which 250 (71%) had new onset, and 100 (29%) had worsening OAB symptoms after COVID hospitalization (Table 1). Follow up at 21- 28 months revealed significant decreases in median OAB and QoL scores for all groups (Table 2). Overall, 270 (87%) of the 310 patients improved with standard therapies (e.g. behavioral modification), with a decrease in the OAB and Qol score from 18 and 19 to 7 and 8 respectively. Of the 250 patients with new onset symptoms, 220 (95.4%) had improvement in symptoms, whereas, of those with existing OAB symptoms only 60 (60.7%) improved. In the later, OAB and Qol scores decreased by 6 points compared with 9-10 in the new onset group, with a lack of return to baseline status. No differences were noted among improvements in symptoms between females and males. CONCLUSION(S): We hereby report the first long-term follow-up of patients who developed CAC and assessed the prognosis of CAC in Long COVID. We found that after 21-28 months, only 13% (40/310) of patients had persistent lower urinary tract symptoms. Patients with Long COVID and CAC may be reassured that symptoms resolves in vast majority of cases and that supportive and reversible treatment should be recommended.
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The impact of COVID-19 on the organs of the genitourinary system is of particular interest to the urologist. There is insufficient information about this influence up to date. The studies are actively developing and require long-term data analysis to determine possible long-term complications, persistent changes in physiological parameters and anatomical and histological structures, as well as to establish the possibility of regression of these changes and complications. The results obtained will undoubtedly improve not only the diagnosis, treatment and prevention of coronavirus infection and its complications, but also make it possible to predict certain disease's outcomes and changes in the function of organs and systems. In turn, this will give an understanding of the measures that need to be taken to completely avoid or minimize these complications and changes. This review focuses on the impact of COVID-19 on genitourinary organs, particularly its place in the development of the lower urinary tract and reproductive organs lesions, as well as the role of androgens in the course of SARS-CoV-2.Copyright © 2021 Vestnik Urologii. All rights reserved.
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Introduction: Synthesized in 1962, ketamine is used as a sedative, antidepressant and for the management of complex chronic pain. More recently, besides its therapeutic use, ketamine has been increasingly used as a recreational drug among young adults. As a result, an increasing number of reports have described side effects associated with its chronic exposure. This review aims to present the current evidence on the toxicity associated with chronic ketamine exposure. Method(s): Considering the limited literature on the topic, Pubmed and Embase were searched and all types of articles were considered, including systematic reviews, retrospective studies, case series and animal studies. Evidence: Chronic ketamine exposure is associated with urological toxicity manifesting mainly by lower urinary tract symptoms with features of ulcerative cystitis. More severe forms with upper urinary tract involvement can require multiple line treatments, including surgery. There are reports of gastrointestinal toxicity with abdominal pain, liver function test derangement and cholangiopathy. More recently, reports have described the association between prolonged ketamine sedation during covid-19 outbreak and cholangiopathies. Development of tolerance, brain and psychiatric changes have been described. These can manifest in cognitive impairment and psychiatric disorders, with schizophrenia-like symptoms. Possible cardiovascular alterations have been described in few reports. Whereas supportive treatment can offer transient relief, ketamine cessation remains the cornerstone of the treatment. Conclusion(s): There is evidence of toxicity associated with chronic ketamine exposure on the different systems studied in this review. Nevertheless, due to the limitation of the studies more prospective studies would be required to clarify those findings.Copyright © 2023 Societe Francaise de Toxicologie Analytique
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Background: How COVID-19 affects lower urinary tract symptoms (LUTS) in men has not been demonstrated by published research. This study examined the de novo development of LUTS and the change in the severity of pre-existing LUTS in men hospitalized with COVID-19. A follow-up period of 12 months after COVID-19 infection provided data on the long-term effect of COVID-19 vs. LUTS. Methods: Data were collected from 70 male patients diagnosed with COVID-19 via nasopharyngeal swab RT-PCR technology between June 2020 and April 2021. The patient’s age, comorbidities, date of COVID-19 diagnosis, date of LUTS, International Prostate Symptom Score (IPSS), prostate-specific antigen (PSA), creatinine, and D-dimer levels, urinalysis, urine culture and duration of hospital stay were recorded. Statistical analyses were conducted to compare between pre-COVID and post-COVID IPSS and other data. Results: 42 patients were included in this study with a, mean age of patients were 54.76 ± 11.95 years. In 8 patients there was no change in IPSS prevs. post-COVID. In the remaining 34 patients (80.9%), the median IPSS increased from a pre-COVID value of 2 to 10 during COVID (p < 0.001). In the subgroup analysis based on age <50 years vs. ≥50 years, statistically significant increase in IPSS were found in both age groups pre- and post-COVID. Conclusions: In male patients of all ages, COVID-19 results in the de novo occurrence of LUTS and an increase in pre-existing LUTS in approximately 80% of patients. These symptoms were found to persist at a 12-months follow-up.
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INTRODUCTION AND OBJECTIVE: To report IPSS, QoL and treatment failure rate up to 79-months for the MT02 study with implantation of the temporary implantable nitinol device (iTind;Medi- Tate Ltd®, Israel) in men with lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO). METHODS: Three out of nine international centers consented to continue the international prospective multicenter study on patients with LUTS due to BPO (IPSS ≥10, Qmax <12ml/sec, and prostate volume <75ml) beyond 36 months following implantation of iTind. Out of the originally enrolled 81 patients, 50 were followed-up at sites in Italy, Switzerland, and Belgium. Due to Covid-19 the originally planned follow-up scheme was amended: Each patient was assessed once during a timeframe of 50-79 months post-operatively by IPSS and IPSS-QoL, change in medication and adverse events via a telephone call. Patients were analyzed in three groups according to their follow-up time point (clustered into groups from 48-59 months, 60-71 months, and 72-83 months). RESULTS: Fifty to 79 months results were available for 42 patients. Four patients were lost to follow-up and two patients deceased from reasons unrelated to the iTind device. Only two patients had treatment failures (one patient underwent TURP, the other ThuLEP), while no patient required any additional medication. IPSS average results were 12.63±8.84 (50-59m, N=24), 8.85±5.54 (60-71m, N =13) and 9.20 ±5.85 (72-79m, N=5). QoL average results were 2.21±1.69 (50-59m, N=24), 1.85±0.99 (60-71m, N=13) and 1.80±1.10 (72-79m, N=5). IPSS (-8.88, -10.31, and -9.60) and IPSSQoL (-2.04, -1.85 and -1.80) improved significantly for all groups vs. baseline, respectively (p <0.0001). Functional data is shown in Figure 1. No late post-operative complications were observed between 50 and 79 months. CONCLUSIONS: iTind for treatment of LUTS secondary to BPO is an effective and safe procedure providing significant and effective reduction in symptoms and quality of life durable up to 79 months (6.6 years) with only 4% of treatment failures after 3-year follow-up. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: Neurodegenerative diseases, such as multiple sclerosis (MS), often lead to the development of neurogenic lower urinary tract symptoms (LUTS). We previously characterized neurogenic bladder dysfunction in a mouse model of MS induced by a coronavirus, mouse hepatitis virus (MHV). The objective of this study was to identify genes and pathways linking neuroinflammation in the central nervous system with urinary bladder dysfunction to enhance our understanding of the mechanisms underlying LUTS in demyelinating diseases. METHODS: Adult C57BL/6 male mice (N=12) received either an intracranial injection of MHV (6,000 PFU) or sterile saline (control). The lumbosacral (L6-S2) spinal cord (SC) segments and urinary bladders were collected during acute infection stage (week 1) and at the first peak of demyelination (week 4) after inoculation with the virus. Total RNA was isolated and analyzed using Nanostring nCounter Neuroinflammation panel. The expression levels of 770 genes associated with neuroinflammation were assessed and compared between the specimens. RESULTS: Transcriptome analysis of SC specimens confirmed a significantly increased expression of 132 genes in MHV mice (tens to hundreds fold change) involved in the regulation of astrocyte, microglia and oligodendrocyte functions, neuroinflammation and immune responses. Out of 132 genes up-regulated in the SC, only 2 genes (siglec1, 46-fold in the SC, 2.6-fold at 1 week and 1.8-fold at 4 weeks in the bladder;and zbp1, 568-fold in the SC, 2.8-fold at 1 week and 2.2-fold at 4 weeks in the bladder) were up-regulated in the urinary bladders of MHV-infected mice. Additionally, two genes were significantly up-regulated (ttr, 2.2-fold at 1week and 1.7-fold at 4 weeks;and ms4a4a, 2.3-fold at 1week and 1.6-fold at 4 weeks), and two were down-regulated (asb2, -1.8-fold at 1 week and -1.6-fold at 4 weeks, and myct1, -1.7-fold at 1week and -1.6-fold at 4 weeks) exclusively in the urinary bladders of MHV mice. CONCLUSIONS: Two genes, siglec1 (encodes type 1 transmembrane protein, expressed in microglia and macrophages, promotes neuroinflammation) and zbp1 (encodes a Z-DNA binding protein, plays role in the innate immune response) link the development of neuroinflammation in the central nervous system with neurogenic changes in the urinary bladders of MHV-infected mice. Further research is needed to establish a functional relationship between expression of these genes and neurogenic LUTS.
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INTRODUCTION AND OBJECTIVE: SARS-CoV-2 utilizes two integral membrane proteins ACE2 and TMPRSS2 for viral replication. It has been established TMPRS22 specifically is found in high concentrations throughout the prostate found to be linked to prostatic disease progression. This project examined the histopathological, ultrastructural, and immunofluorescent elements of prostatic tissue from men infected by SARS-CoV-2. METHODS: We evaluated prostate tissue in men with worsening lower urinary tract symptoms who underwent HoLEP procedure after SARS-CoV-2 infection. Biopsied tissue was visualized by transmission electron microscopy (TEM), immunofluorescence, and viral presence was confirmed by quantitative polymerase chain reaction (RT-PCR). RESULTS: Multiple coronavirus-like spiked viral particles ranging from 73.3mm to 109mm were visualized by TEM (Figure). Histochemical and immunofluorescence concurrently showed presence of distinct hyalinization, fibrosis, and presence of spike protein (Figure 2). RT-PCR confirmed the identity of the viral bodies as SARS-CoV-2 (Figure 3). CONCLUSIONS: This study provides evidence that SARSCoV- 2 not only enters prostatic tissue but may persist beyond initial infection period. In addition to establishing the persistence of SARSCoV- 2 particles in prostatic tissue, this report suggests the importance of discerning the relationships between COVID-19, lower urinary tract symptom severity, and prostatic hyperplasia. (Figure Presented).
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Introduction & Objectives: The current coronavirus disease 2019 (COVID-19) pandemic is creating huge pressure on our health care systems and has led to dramatic changes in our daily lives. Many countries have enforced strict controls on movement and socializing in an effort to manage the pandemic. Both, in-patient and out-patient care has been affected. There is big gap between health care service providers and patients and because of that many people are suffering. But telemedicine appears to be only bridge between them so that patients can get maximum benefit from the experts. This study is being conducted to know the worth of telemedicine in urology during ongoing COVID pandemic and for future prospect. Materials & Methods: All the patients who made a call on telemedicine contact number of department of urology of our tertiary care hospital and took advice for their treatment or follow up from April 2020 to December 2020, were included in this prospective observational study. Patients contacted us through various modalities like Voice/video call, WhatsApp chat, messages. Patients who contacted us for non-urological problem were excluded. All calls were answered by Professional Urologist and advice was given verbally as well as sent them in written on a prescription slip through WhatsApp. Data collection included age, sex, place, symptoms and advice given. Results: During the study period, we received 1102 calls from the patients of North India, 124 patients were excluded for being non-urological and 978 patients were included. 94% patients contacted us through voice call, 4% through video call and 2% through chat only. Average duration of call was 16 minutes and 25 seconds. 68% patients were males, while 32% females. 54% patients were younger than 40 years and only 15% were elder than 60 years. Common reasons for calling us were- urinary tract infection (23%), lower urinary tracts symptoms (21%), renal stone disease (17%), haematuria (11%), post-operated cases (11%) and sexual problems (7%). Approximately 16% patients had some urological malignancy. Only 18% patients contacted us for acute illness of duration <1 week, while 47% patients were sick for >4 weeks. 18% patients needed only counselling for their disease, 65% required prescription and conservative management. 17% patients were requiring in-hospital management so referred to nearby urological center for urgent intervention or care. None of the patients had any problem in getting medications from pharmacy. Conclusions: Telemedicine provides specialized clinical support for urologists and patients just by using mobile phones, as a logistically feasible alternative to face-to-face consultation. 83% of cases were successfully managed just by telemedicine and very useful for reducing the risk of transmission of COVID-19 infection. This novel way of urological practice should be continued in future to reduce unnecessary visits to medical facilities even after this pandemic.