Exacerbation of Urinary Storage Symptoms by the Psychological Stress Induced by the COVID-19 Pandemic.

BACKGROUND/AIM: This study aimed to determine whether psychological stress associated with the COVID-19 pandemic might exacerbate lower urinary tract symptoms (LUTS) and decrease lower urinary tract function in outpatients with LUTS. PATIENTS AND METHODS: We evaluated 104 patients who visited our hospital during the first wave of the COVID-19 pandemic. Psychological stress was evaluated by the Stress Response Scale-18 (SRS-18). Subjects were divided into aggravation and non-aggravation of psychological stress groups according to the SRS-18. LUTS was evaluated according to the International Prostate Symptom Score (IPSS). Lower urinary tract function was evaluated as the post-void residual urine volume (PVR). Comparisons of scores and changes in scores of each parameter before versus during/after the first wave of the COVID-19 pandemic were performed between the two groups. RESULTS: Forty-two patients were included in each group. We observed no significant differences in the comparison of scores at each time point and in changes in total IPSS score, voiding symptom subscores and PVR between the two groups. Although no significant differences in storage symptom subscores were observed between the two groups, changes in storage symptom subscores increased significantly during the first wave of the pandemic in the aggravation of psychological stress group (p=0.02). However, no significant increase was observed after the first wave. CONCLUSION: Psychological stress during the COVID-19 pandemic might transiently aggravate storage symptoms in patients with LUTS. Physicians should be aware of the possibility of transient worsening of LUTS during future pandemics, and transiently additional medication might be effective in such patients.

The Effect of Covid-19 Severity on Lower Urinary Tract Symptoms Manifestations.

Background: The dominant symptoms in the patient with COVID-19 are symptoms of the respiratory organ system such as cough, rhinorrhea, dan shortness of breathing. Nonetheless, some reports found involvement of another organ system, including the gastrointestinal system, cardiovascular system, central nervous system, urinary system, such as lower urinary tract symptoms. Hematuria related to infection of COVID-19 virus on adult and kids were reported. Urinary frequency related to infection of the covid-19 virus was also reported. However, the association between covid-19 infection and lower urinary symptoms was still unknown. Objective: This study aims to identify the effect of covid-19 infection on lower urinary tract symptoms manifestation on the patient with COVID-19 treated in Field Hospital. Methods: The design of this study is cross-sectional. After inclusion and exclusion criteria, the male and female patients were then asked based on question points from the International Prostate Score and latest condition related covid-19. In addition, we statistically analyzed the association and the effect between these two variables. Results: Six hundred and six COVID-19 confirmed patients were included in this study. The most frequent complaints of lower urinary tract symptoms were frequency. The severity of the covid-19 correlates with the lower urinary tracts symptoms score. Conclusion: The most common lower urinary tract symptoms are frequency, urgency, and nocturia. These lower urinary tract symptoms may increase in severity with the severity of the infection from COVID-19. The severity of COVID-19 has a significant effect on the increase in lower urinary tract symptoms.

Lower urinary tract symptoms and mental health during COVID-19 pandemic.

OBJECTIVE: Coronaviruses (CoVs) are a group of RNA viruses involved in several human diseases affecting respiratory, enteric, hepatic, and neurological systems. COVID-19 was identified in 2020 and was named SARS-CoV-2. To limit worldwide contagion, many countries instituted a lockdown, which conducted to disruption of routine life. In fact, pandemic was associated with several stresses among population, such as loss of employment, deaths of family members, friends, or colleagues, financial insecurity, and isolation. This led to long-lasting psychosocial effects as anxiety and depression, increasing the prevalence of stress and traumarelated disorders in the population. The aim of this study was to investigate the correlation between lower urinary tracts symptoms (LUTS) and stress/depressive symptoms during COVID-19 pandemic. MATERIALS AND METHODS: An anonymous cross-sectional webbased survey (comprehending anthropometric data, education level, occupation status, smoking and alcohol habits, current therapies, quarantine and COVID-19 infection status) was conducted from March to May 2020 in Italy. LUTS were examined through National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and Genitourinary Pain Index (GUPI). Hamilton Depression Rating Scale (HDRS) was utilized to evaluate depressive and anxiety symptoms. Non-parametric Kruskal-Wallis H Test was used for statistical analysis. RESULTS: A total of 356 out of 461 subjects fully completed the survey, with a response rate of 77.2%. Data showed that subjects involved in economic difficulties, quarantine measures or with increased HDRS reported a significative statistic worsened urinary symptoms (H(3) = 11.731, p = 0.008), quality of life, (H(3) = 10.301, p = 0.016), total NIH-CPSI/GUPI score (H(3) = 42.150, p = 0.000), and quality of life (H(3) = 48.638, p = 0.000). CONCLUSIONS: COVID-19 pandemic provoked several alterations in everyday life. Although general lockdown, quarantine and social distancing have been necessary to prevent virus spreading, this had long term effects on all population in terms of mental and physical health. NIH-CPSI and GUPI scores increased linearly with stress and anxiety levels measured at HDRS, confirming worse LUTS in subjects who suffered anxiety and stress from COVID-19 pandemic.

Impact of coronavirus disease on the management of lower urinary tract symptoms and voiding dysfunction.

PURPOSE OF REVIEW: Coronavirus disease (COVID-19) has caused a crisis in the entire healthcare system since its emergence. The urgency and priority of various diseases have impacted the medical and surgical treatment in this period. We aim to review the impact of COVID-19 on lower urinary tract symptoms (LUTS) and management. RECENT FINDINGS: There may be a relationship between COVID-19 and de novo or increased LUTS. Patients with LUTS should also be evaluated for COVID-19. Management of diseases has varied during the COVID-19 due to the density of the pandemic. Virtual consultations can mitigate patients who are postponed or cancelled, such as patients with LUTS. Patients suffering voiding dysfunction may manage with oral medications such as alpha blocker and 5-alpha reductase inhibitor via telemedicine. Minimally invasive procedures with a low risk of complications and a short hospitalization time should be considered in complicated cases such as the inability to catheterize. SUMMARY: Telemedicine should be implemented on managements of noncomplicated LUTS and voiding dysfunction. Each centre can schedule its LUTS management approach according to the density of pandemic. Virtual consultations need to be developed to compete with face-to-face consultations.

Impact of COVID-19 pandemic on lower urinary tract symptoms in patients with benign prostatic hyperplasia and predictors of urine retention in such patients.

OBJECTIVES: We assess the effect of coronavirus disease 2019 (COVID-19) on lower urinary tract symptoms (LUTS) of patients with benign prostatic hyperplasia (BPH). Moreover, we delineate risk factors for urine retention in such patients. METHODS: All COVID-19 infected males were expeditiously evaluated. All enrolled patients were assessed using the International Prostate Symptom Score (IPSS), uroflowmetry, and pelvi-abdominal ultrasonography for prostate volume and postvoiding residual urine (PVR) estimation. RESULTS: Fifty patients, who were diagnosed with BPH, were enrolled. The mean age (±SD) was 62.64 ± 7.69. In the pre- and post-COVID-19 group, the mean (±SD) IPSS was 13.42 ± 4.32 and 26.62 ± 5.77, respectively (P < .001), while PVR was 90.40 ± 32.75 and 185.42 ± 73.42, respectively (P < .001), and maximum flow rate was 14.40 ± 2.75 and 10.74 ± 3.43, respectively (P < .004). After infection with COVID-19, 13 (26%) patients were managed by urethral catheter fixation owing to urine retention. On bivariate analysis, age, diabetes, large prostate on digital rectal examination, alpha-blocker monotherapy, microscopic hematuria, positive urine culture, and pre-COVID-19 IPSS were significantly correlated with urine retention (P < .001, P = .01, P < .001, P = .06, P < .001, P = .04, and P < .001, respectively). On multivariate analysis, age, pre-COVID-19 IPSS, and positive urine culture were the independent predictors of urine retention (P = .05, P < .001, and P = .01, respectively). CONCLUSION: LUTS in BPH patients were significantly affected by COVID-19. COVID-19 increases IPSS leading to a change in the treatment modality of BPH. On multivariate analysis, age, pre-COVID-19 IPSS, and positive urine culture were the independent predictors of urine retention post COVID-19 infection.

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).

Challenging retrovesical mass in men: report of a rare liposarcoma case with concurrent COVID-19 infection.

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.