The COVID-19 pandemic what have urologists learned?. jQuery(function($) { Coto, E., Avanzas, P. & Gmez, J. Reprod. There is a link between COVID-19 and symptoms that resemble overactive bladder (OAB). Aging https://doi.org/10.18632/aging.202224 (2020). In patients with so-called long COVID (a complex condition characterized by prolonged heterogeneous symptoms following SARS-CoV-2 infection, such as weakness, general malaise or fatigue15), mounting evidence of impairment or scarring of multiple organs has been reported16. Severe structural changes can be detected in kidney biopsy samples from patients with COVID-19 (refs41,42). Regarding urology, no evidence of male or female fertility reduction following COVID-19 vaccination has been reported139. Patients with highly prevalent risk factors, such as diabetes, obesity or hypertension, are at an increased risk of developing SARS-CoV-2-mediated AKI (adjusted odds ratio (OR): 1.76 for diabetes, 1.11 for obesity and 1.25 for hypertension)36,37. Ye, Q., Wang, B. Pediatr. Results from the univariate analysis showed that total testosterone levels were inversely associated with increased risk of ICU admission (OR 0.54, P<0.0001) or death (OR 0.68, P<0.002)92. Med. Andrologia 53, e13973 (2021). Infect. 3). The Lancet Oncology. 69, 11811189 (2020). Drake, T. M. et al. Viruses in the mammalian male genital tract and their effects on the reproductive system. It causes waste to build up in your blood and can be deadly. High ACE2 expression levels were found in kidney proximal tubule cells (4% positivity) and in bladder urothelial cells (2.4% positivity)17. The https:// ensures that you are connecting to the Luppi, F., Arpino, B. Results from autopsy studies on patients deceased of COVID-19-associated causes reported severe tissue alterations in various organs6,7. CAS Int. Res. Public Health 194, 245251 (2021). However, SARS-CoV-2 was detected in urine up to 52days after disease onset, indicating that the virus might be detectable in urine in the acute stage of COVID-19 and also after recovery58. Tregoning, J. S. et al. Pathol. Carneiro, F. et al. Nat. Acute Cardiovasc. Mol. SARS-CoV-2 is rarely detected in semen. Article 34, 267268 (2021). The vaccine should slow the spread of COVID-19 around the world. Front. Cell 181, 271280 e278 (2020). Med. PubMed Central Prostate-localized and androgen-regulated expression of the membrane-bound serine protease TMPRSS2. The incidence of thromboembolism in patients with COVID-19 is similar to that observed in non-COVID-19 pneumonia121, but the pathophysiological background seems to be completely different123,124,126. fast heartbeat. The perspective of when the COVID-19 pandemic will end is mainly influenced by two factors: the progress of vaccine programmes and the spread of variants of concern152. Dis. Sun, M. et al. Is there any association of COVID-19 with testicular pain and epididymo-orchitis? Annu. The COVID-19 pandemic what have urologists learned? (2022). People with COVID-19 appear to be more likely to develop LUTS than those who have not had a SARS-CoV-2 infection, even if they had no symptoms. Arab J Urol. 30, 484487 (2020). On this basis, cell types with >1% of ACE2+ cells were defined as being at a high risk of SARS-CoV-2 infection17. In another study, impaired sperm quality in patients with COVID-19 was attributed to recurrent fever81, which has been shown to have a detrimental effect on sperm quality84, potentially owing to the thermal dependence of spermatogenesis85,86. the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in A bladder infection is a type of urinary tract infection (UTI). Research notes that COVID-19 appears to worsen existing OAB or causes new symptoms, such as urinating more often or urgently. One possible pathophysiological mechanism of AKI in COVID-19 is a cytokine-storm-induced systemic inflammatory response31,41. The co-expression level of ACE2 and TMPRSS in these cells was similar to that observed in the lung, supporting the hypothesis that the kidney might be a main target organ for SARS-CoV-2 (ref.55). Microbiol. Severely low testosterone in males with COVID-19: a case-control study. Immunol. 11, 1446 (2020). & Wang, J. ACE2 expression in kidney and testis may cause kidney and testis infection in COVID-19 patients. Ann. TMPRSS2 is, in fact, predominantly expressed in prostate epithelium23 and is upregulated in prostate cancer with high Gleason grades24. Diagnostics https://doi.org/10.3390/diagnostics11040581 (2021). Practical Insights for Pharmacists: Drug and Vaccine Considerations for Acute Outpatient COVID-19. Reprod. Lancet 398, 223237 (2021). & Mao, J. 31, 19591968 (2020). Rep. Urol. Zou, X. et al. Cell Biol. PubMed Studies from around the world suggest that 7% to 31% of Covid-19 patients experience some sort of cardiac injury. Charumilind, S. et al. https://doi.org/10.1056/CAT.1020.0193 (2020). The severity of COVID-19 infection (for example, the need to be hospitalized) and the presence of fever did not correlate with sperm characteristics in this study87. The COVID-19 pandemic has impacted every corner of the globe. J. Impot. Article Most people recover from COVID-19 in around 1 week. Microbiol. This could include: A doctor may also ask a person to keep a bladder diary for a few weeks. Immunol. Learn More. Overall, 42 patients were enrolled and randomized 2:1 to receive 5 days of treatment with enzalutamide or standard of care117. Mortality among US patients hospitalized with SARS-CoV-2 infection in 2020. But we have seen how it can affect multiple organs, including the liver, pancreas, small intestine and even gallbladder. Adam, D. Will Omicron end the pandemic? Biol. 73, 132133 (2021). Liu, C., von Brunn, A. Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. Carlsen, E., Andersson, A. M., Petersen, J. H. & Skakkebaek, N. E. History of febrile illness and variation in semen quality. Low Rates of Urologic Side Effects Following Coronavirus Disease COVID-19 and cancer: 1 year on. Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19. A 2022 study emphasizes the need for more research into whether COVID-19-related LUTS are reversible. 383, 22552273 (2020). Learn more here. Transl. Ediz, C. et al. The median age of the patients reporting urologic symptoms was 63 years (IQR 44-79, Range: 19-96) and 54% of the patients were female.Urologic symptoms reported after COVID-19 vaccination are extremely rare. All rights reserved. Li, H. et al. Pathophysiological mechanisms leading to AKI development in patients with COVID-19 have not yet been fully elucidated and are probably multifactorial. Clin. Bookshelf If COVID-19 affects a persons urinary tract, they may need to urinate: In some cases, people have also reported passing blood or pus in their urine. doi: 10.1002/jmv.26996. Exam findings were consistent with vulvar aphthous ulcers. 18, 256264 (2021). Careers. A cytokine storm is characterized by an excessive and maladaptive release of pro-inflammatory cytokines during an inflammatory response, which can lead to excessive organ dysfunction47. Chronic bladder infection: Is there a cure? - Mayo Clinic In kidney epithelial cells, a novel route of viral invasion for SARS-CoV-2 mediated by the interaction of spike proteins with CD147 (a transmembrane glycoprotein also known as basigin) has been described56,57, suggesting that other ACE2-independent mechanisms of viral invasion in the kidney might exist and warrant further investigation. & Lakatta, E. G. The dilemma of coronavirus disease 2019, aging, and cardiovascular disease: insights from cardiovascular aging science. . N. Engl. Open 3, e208292 (2020). 93, 206222 (2021). Thus, whether the glomerular changes observed in this population (African American and Hispanic patients with COVID-19 who express the G1 and G2 risk alleles of APOL1) are a direct consequence of SARS-CoV-2 infection or emerge as a form of a second hit additional to a pre-existing risk factor is still unclear46. Hamming, I. et al. CAS Andrologia 50, e13140 (2018). PubMed Scientists theorize this could be a factor in post-COVID-19 LUTS, but more research is necessary to prove this. & Senel, E. Evaluation of COVID-19 vaccine refusal in parents. Acute kidney injury in patients hospitalized with COVID-19 from the ISARIC WHO CCP-UK Study: a prospective, multicentre cohort study. and transmitted securely. Department of Urology, Ludwig-Maximilians-University, Munich, Germany, Benedikt Ebner,Yannic Volz,Jan-Niclas Mumm,Christian G. Stief&Giuseppe Magistro, You can also search for this author in Liu, X. et al. Bioinformatic and mouse model reveal the potential high vulnerability of Leydig cells on SARS-CoV-2. Bethesda, MD 20894, Web Policies Lee KS, Yoo TK, Liao L, Wang J, Chuang YC, Liu SP, Chu R, Sumarsono B. BMC Urol. Urology soon emerged as a focus of interest, owing to a potential threat of long-term damage induced by COVID-19 to kidney function, fertility and hormonal balance. Intern. https://doi.org/10.1016/j.kint.2021.07.015 (2021). AKI was reported to be the most common complication of COVID-19 in a multicentre cohort study including 80,388 patients with COVID-19 (ref.33). Furthermore, thinning of seminiferous epithelium was observed in deceased patients with COVID-19, and the proportion of apoptotic cells in testes of these patients was significantly higher (2.95-fold, P=0.018) than the average of deceased men without COVID-19. Spirito, L. et al. Leukocytes are white blood cells. Gorog, D. A. et al. Erbay, G. et al. Fountain, J. H. & Lappin, S. L. Physiology, Renin Angiotensin System. Article Lancet Haematol. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); The content of this site is intended for healthcare professionals. Single-cell transcriptome analysis of the novel coronavirus (SARS-CoV-2) associated gene ACE2 expression in normal and non-obstructive azoospermia (NOA) human male testes. Many of the reported symptoms of COVID-19 vaccination (LUTS, haematuria and urinary infection) have the same prevalence in vaccinated and unvaccinated individuals; thus, a causal attribution to the vaccination seems unlikely140. Do androgens modulate the pathophysiological pathways of inflammation? Kadihasanoglu, M., Aktas, S., Yardimci, E., Aral, H. & Kadioglu, A. SARS-CoV-2 pneumonia affects male reproductive hormone levels: a prospective, cohort study. Hum. Urol. Arch. Results from a single-cell transcriptome analysis of 15 kidney samples from healthy individuals showed co-expression of ACE2 and TMPRSS in the kidney, especially in proximal tubular cells and podocytes55. J. Trop. Cancer screening tests and cancer diagnoses during the COVID-19 pandemic. The presence of SARS-Cov-2 viral RNA in ejaculate has only been reported in four studies to date62,63,64,65 (6.66%62, 15.8%63, 2.3%64 and 14.3%65 of patients). B.E., G.M., Y.V. J. Kidney Dis. As males and older adults are more susceptible to COVID-19 in general, it seems that LUTS may be part of an overall higher burden of illness in these groups. J. Scientists use genetic rewiring to increase lifespan of cells, Beyond amyloid and tau: New targets in developing dementia treatments, Napping longer than 30 minutes linked to higher risk of obesity and high blood pressure, Activity 'snacks' could lower blood sugar, complication risk in type 1 diabetes, In Conversation: Investigating the power of music for dementia, Urinary tract infection (UTI) symptoms, causes, and remedies, New COVID-19 strain: What to know about 'Arcturus', Swollen sinuses and COVID-19: What to know, gastrointestinal system, which is responsible for digestion, cardiovascular system, which pumps blood around the body, urinary system, which includes the bladder and urinary tract, less commonly, a cystoscopy or urodynamic testing, the frequency and amount a person urinates, symptoms such as feelings of urgency or urine leakage. The immunity someone gains from having an infection, called natural immunity, varies from person to person. While there is a link between COVID-19 and new LUTS, the virus that causes COVID-19, SARS-CoV-2, may not be the direct cause in all cases. Urogynecological survey in a group of Italian women treated for overactive bladder: Symptoms and quality of life analysis during the COVID-19 period. Expert Rev. The experience of European pulmonary pathologists. Pediatr. However, the exact effect of testosterone on COVID-19 severity and the underlying mechanisms are still unclear, as reflected in the contradictory findings about the effect of ADT on the risk of SARS-CoV-2 infection107,110. Bogoch, I. I. et al. Multivariate regression revealed that pre-vaccinated OAB (p = 0.003) was a risk for the deterioration of storage LUTS. Research notes that COVID-19 appears to worsen existing OAB or causes new symptoms, such as urinating. Nephrol. Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Dis. Front. Machado, B. et al. Philos. Doctors may try existing treatments instead. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. ISSN 1759-4820 (online) Nephrol. We have looked at the bladder and we have found declining white cells living in the bladder. A total of 156 urologic symptoms were described amongst the 113 adverse event reports. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. They're caused by bacteria and lead to problems like pain in your lower belly and having to pee way more often . We queried the FDA Vaccine Adverse Event Reporting System (VAERS) for all reported symptoms following the Pfizer-BioNTech and Moderna vaccines as of February 12th, 2021. Men might be more vulnerable to infections than women owing to biological causes (including immunological, hormonal and genetic differences) and a worse overall health status102; the higher prevalence of smoking in men than in women might also predispose to worse COVID-19 outcomes102. Finelli, L. et al. Thus, urine samples from patients and age-matched individuals were collected72; all patients positive for COVID-19 (n=4) had significantly higher levels of IL-6 (P=0.046) and IL-8 (P=0.002) in urine than individuals in the COVID-19-negative group (n=4)72. In another study, men recovering from COVID-19 (n=30, median age: 40 years) showed a lower total sperm number than age-matched healthy men89. Long-term effects of viral orchitis caused by viruses such as mumps, HIV or hepatitis B virus on fertility have been extensively studied74. J. In March 2020, the WHO declared the COVID-19 outbreak a pandemic. Emerg. The detection of SARS-CoV-2 in urine and semen is very rare; however, a possible risk of transmission through these body fluids has not yet been ruled out. & Azarpira, N. Covid-19 pathogenesis in prostatic cancer and TMPRSS2-ERG regulatory genetic pathway. 39, 251.e255251.e257 (2021). There are no specific treatments for COVID-19-related urinary symptoms. COVID-19 Vaccine | Experts Provide Guidance On Vaccination While Being Treated for Bladder Cancer. Clipboard, Search History, and several other advanced features are temporarily unavailable. J. Clin. Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA. 36, 15201529 (2021). -. Schiavi, M. C., et al. A phase 2 trial of the effect of antiandrogen therapy on COVID-19 outcome: no evidence of benefit, supported by epidemiology and in vitro data. Electronic address: Jennifer.Anger@cshs.org. If a person still has COVID-19, their symptoms may be a direct result of SARS-CoV-2, or the coronavirus. Nature Reviews Urology thanks A. Kadioglu and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. PubMed Central Nat. COVID-19 vaccine safety in the U.S. Uses text messaging and web surveys to check in with vaccine recipients after vaccination . doi: 10.3346/jkms.2021.36.e153. Barry, M. J. et al. Of 889 subjects, up to 13.4% experienced worsened storage LUTS after vaccination. Achua, J. K. et al. A case of SARS-CoV-2 However, these effects might also be attributed to fever, and long-term data on sperm quality after recovery from COVID-19 are still very limited. Vaccines. Cardiol. Baek, M. S., Lee, M.-T., Kim, W.-Y., Choi, J. C. & Jung, S.-Y. China Life Sci. Vaccines for COVID-19 are considered an essential part of the strategy for ending the pandemic136, but one major reason for COVID-19 vaccine refusal is anxiety about adverse effects137,138. 26, 415425 (2021). }); In a meta-analysis of eight studies including 160 semen samples from patients with COVID-19, SARS-CoV-2 was only detected in six patients from one study61. Side effects of BNT162b2 mRNA COVID-19 vaccine: A randomized, cross-sectional study with detailed self-reported symptoms from healthcare workers. However, the Omicron variant induces a considerably milder disease at the population level and has been shown to trigger cross-protective immunity towards the Delta variant135. In a study analysing kidney biopsy samples from 14patients with COVID-19, 5 patients had collapsing glomerulopathy, 1 had minimal change disease, 2 had membranous glomerulopathy, 1 had crescentic transformation of lupus nephritis, 1 had anti-glomerular basement membrane nephritis and 4 had isolated acute tubular injury41. FOIA The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. 36, 234240 (2021). Podocytes have a crucial role in urine filtration, and proteinuria has been observed in patients with COVID-19 (44% of patients (n=701) in a prospective study)35. Quinn-Scoggins, H. D. et al. Deidda, S. et al. Cystitis refers to inflammation of the bladder. COVID-19 can cause tiny clots to form in the bloodstream, which can clog the smallest blood vessels in the kidney and impair its function. Given the common prevalence of many of these reported symptoms in the general population, there does not appear to be a correlation between vaccination and urologic symptoms, but as the vaccination criteria expands, further monitoring of the VAERS is needed.Copyright 2021.
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