Recommendations for the Management of Patients with Benign Prostatic Hyperplasia in the Context of the COVID-19 Pandemic: A Retrospective Study of 314 Cases.

Aim: Through investigation and analysis of the course management of 314 patients with benign prostatic hyperplasia (BPH) during the COVID-19 pandemic, we expected to offer effective recommendations for the management of patients with BPH against the background of the COVID-19 pandemic. Methods: We implemented telephone follow-ups of 314 patients with BPH who were diagnosed at the Urology Clinic of Xiangya Hospital of Central South University before January 24, 2020, and who were admitted to the hospital for reexamination after the epidemic was controlled in China, and we conducted research and analysis of their disease management during the COVID-19 pandemic. Results: In the follow-up, we found 245 patients (79.3%) over 60 years of age and 187 patients (60.5%) with underlying disease. There were 47 patients (15.2%) who returned for consultation during the COVID-19 pandemic, and of these, 18 were admitted to the hospital for follow-up consultation, and 29 patients underwent consultation via the internet or telephone. Eleven patients underwent surgery during the pandemic, and of these, three experienced emergency surgery. We encountered 65 patients (24.4%) who self-administered medications irregularly and 54 patients (20.3%) who self-medicated and adjusted the dosage and drug types themselves. There were 302 patients (97.7%) who wished to be reexamined during the COVID-19 pandemic. In terms of treatment, the proportion of patients "awaiting observation" declined from 13.9% to 4.4%, and the proportion of patients "awaiting surgery" increased from 4.9% to 16.4%. Using the International Prostate Symptom Score (IPSS) scale, the percentage of patients with moderate-to-severe symptoms increased from 79.9% to 90.1%, and the proportion with a quality of life (QOL) score ≥ 5 rose from 82.5% to 88.9%. The proportions of patients exhibiting storage, voiding, and postmicturition symptoms in lower urinary tract symptoms (LUTS) increased from 77.3%, 21.7%, and 18.8% to 91.9%, 27.5%, and 25.5%, respectively; those manifesting hematuria and urinary retention increased from 0.9% and 0.6% to 2.3% and 1.7%, respectively; those with a prostate specific antigen (PSA) > 4 ng/ml rose from 10.0% to 15.1%; patients with a maximum flow rate (Qmax) < 15 ml/s increased from 82.5% to 92.3%, and the proportion with a Qmax < 10 ml/s increased from 8.7% to 15.4%; the individuals with a prostate volume > 30 ml increased from 94.1% to 97.0%; the percentage of men with a bladder residual urine volume > 10 ml was augmented from 81.6% to 89.3%, and patients with prostate nodules on physical examination were elevated from 1.0% to 1.7%. We uncovered no prostate cancer in patients, and the proportion of patients administered the combination drug increased from 78.9% to 91.2%. Compared with patients receiving online or telephone consultations, patients undergoing reexamination at the hospital were better controlled. When we conducted a survey of whether patients chose to go to a public or private hospital for follow-up, we found that 46.6% of the patients chose to go to a private medical institution. Conclusions: COVID-19 greatly affected the treatment of patients with BPH. When conditions permit, we recommend that patients first consider going to the hospital for evaluation; however, when this is not possible, medical institutions should provide telephone or online consultation for patients with BPH. Surgical treatment should also be arranged for those in need as soon as possible to avoid delaying the patient's treatment.

Is COVID-19 a risk factor for progression of benign prostatic hyperplasia and exacerbation of its related symptoms?: a systematic review.

BACKGROUND: To explore the potential mechanisms of SARS-CoV-2 in targeting the prostate gland, leading to exacerbation of benign prostatic hyperplasia (BPH) symptoms and greater risks of BPH complications such as acute urinary retention. METHODS: A categorized and comprehensive search in the literature has been conducted by 10 April 2021 using international databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library in line with the PRISMA guidelines recommendations. PICO strategy was used to formulate the research question. The following terms were used: urology, COVID-19, coronavirus, BPH, inflammation, androgen receptors, LUTS, IPSS, PSA, and SARS-CoV-2 or a combination of them. Studies with irrelevant purposes and duplicates were excluded. The selected studies were performed on humans and published in English. RESULTS: The research revealed 89 articles. After title screening and considering exclusion criteria, 52 papers were included for the systematic review. BPH is a common condition affecting older men. SARS-CoV-2 infects the host cell by binding to angiotensin converting enzyme 2 (ACE2). A hyperactivated RAS system during infection with SARS-CoV-2 may lead to activation of pro-inflammatory pathways and increased cytokine release. Thus, this virus can lead to exacerbation of lower urinary tract symptoms (LUTS) and trigger inflammatory processes in the prostate gland. Since androgen receptors (AR) play an important role in the BPH pathophysiology and infection with SARS-CoV-2 may be androgen-mediated, BPH progression and its related symptoms can be a complication of COVID-19 through AR involvement and metabolic disturbances. CONCLUSIONS: Based on the current findings, SARS-CoV-2 can possibly damage the prostate and worsen BPH and its related LUTS through ACE2 signaling, AR-related mechanisms, inflammation, and metabolic derangement. We encourage future studies to investigate the possible role of COVID-19 in the progression of BPH-related LUTS and examine the prostatic status in susceptible patients with relevant available questionnaires (e.g., IPSS) and serum biomarkers (e.g., PSA).

Impact of COVID-19 outbreak on urology surgical waiting lists and waiting lists prioritization strategies in the Post-COVID-19 era. / Impacto del brote de COVID-19 en las listas de espera de cirugía urológica y estrategias de priorización en la era post-COVID-19.

INTRODUCTION: The suspension of most elective surgeries during COVID-19 pandemic caused the lengthening of urology surgical waiting lists. The objective of this study is to evaluate the impact of COVID-19 pandemic on urology surgical waiting list in a high-volume hospital. METHODS: An observational descriptive study was designed. All patients included in the urology surgical waiting list of our high-volume center on May 1st 2020 (46 days after the suspension of elective surgery) were analyzed. Baseline variables, priority on the waiting list, main urological disease, type of scheduled surgery, and waiting time were recorded. Other variables recorded were the presence of a urinary catheter, number of accesses to the emergency department, evidence of COVID-19 infection, number of deaths and their cause. The waiting time for each disease was compared with the time to surgery in 2019. RESULTS: A total of 350 patients were included. The mean (SD) time on the waiting list was 97.33 (55.47) days. Priority 1 patients, who normally should undergo surgery within 30 days, were on the waiting list for a mean (SD) time of 60.51 (20.14) days. They were mainly patients with ureteral lithiasis (25.6%), high-risk or muscle-invasive bladder cancer (20.9%) and high-risk prostate cancer (13.9%). The mean waiting time had already significantly exceeded the mean time to surgery in 2019 for radical cystectomy (p = 0.04) and URS (p = 0.003). CONCLUSIONS: The suspension of most elective surgeries due to COVID-19 had a significant impact on urology surgical waiting list of our high-volume center, especially in priority 1 group.

The Effect of the Presence of Lower Urinary System Symptoms on the Prognosis of COVID-19: Preliminary Results of a Prospective Study.

PURPOSE: To investigate the effectiveness of benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS), which occur as a natural result of aging and androgen exposure, in predicting disease prognosis in male patients diagnosed with COVID-19. METHODS: The study was planned prospectively. The study included 63 male patients over 40 years of age diagnosed with COVID-19. The patients were diagnosed with COVID-19 based on the results of reverse transcription polymerase chain reaction tests of oropharyngeal and nasopharyngeal swabs obtained as per the World Health Organization guidelines. The presence of LUTS was assessed by the International Prostate Symptom Score (I-PSS), a subjective assessment, and the I-PSS was filled for the patients included in the study. The patients were divided into three groups based on their scores in the I-PSS survey: group 1: mild (0-7), group 2: moderate (8-19), and group 3: severe (20-35). The data of all three groups were statistically analyzed. RESULTS: In the assessment performed between the groups, it was identified that for patients in group 3, the length of hospital stay was longer, intensive care requirement was more frequent, and their mortality rates were numerically higher. In the evaluation made regarding the time to intensive care admittance, this was identified to be the shortest in group 3. CONCLUSION: As a result of our study, we think that in patients with COVID-19, BPH-related LUTS can guide clinicians in predicting prognosis.