Discussion
Viral infections of the lower urinary tract are specially detected in
immuno-compromised patients and are the major cause of hemorrhagic
cystitis in the solid organ and stem cell transplant recipients
(9-1,2,3). To define viral cystitis, the viral pathogen should be
evaluated from a urine sample and the patient must have hematuria,
abdominal pain, urgency, frequency, pyuria and/or hematospermia (9). To
date, COVID-19 was only be isolated from urine samples by Sun et al (8).
Then Lie et al found that while urine occult blood, proteinuria, and the
urine potential of hydrogen were higher in COVID-19 patients than in
healthy controls, the urine specific gravity value was lower in patients
than in healthy controls (1). In addition, they reported that the
positive rates of glucosuria and proteinuria in the severe and critical
groups were higher than those in the moderate group, as a result, they
also suggested that urine findings could be useful for the evaluation of
the illness (1).
Mumm et al suspected that if the patients had any urinary symptoms after
they had treated a patient with COVID-19 presented as urosepsis (5).
Then they evaluated 57 COVID-19 patients retrospectively and found that
seven male patients had a urinary frequency (5). After this study’s
findings, Luciani et al reported three cases of COVID-19 who had gross
hematuria (6). They recommended that clinicians should be aware that
COVID-19 patients, especially those who had a history of urinary tract
disease, could apply to the hospital with urinary tract symptoms (6).
In this study we evaluated COVID-19 patients for LUTS with validated
instruments retrospectively for the first time. We excluded all medical
and surgical conditions that might affect urinary tract symptoms and
cause LUTS from the study. We found that the male patients did not have
significant voiding symptoms during the illness or after the treatment,
and these symptoms did not affect their quality of life. However, the
storage symptoms were seen before the early time of illness and during
COVID 19. With the discharge from hospital, these symptoms had
disappeared. It could be explained that the storage symptoms might have
occurred after the patient had been infected by the virus, so the
storage symptoms may be one of the first symptoms of COVID-19 along with
a fever or cough. In the female patients it could be said that the
obstructive symptoms were similar before, during and after the illness.
As with the male patients, the female patients had overactive bladder
symptoms at the start of the illness and during hospitalized time,
however these symptoms were cured at the time of resting at the home.
When the medical reports of the patients were examined, any intravenous
fluid supply or oral hydration therapy which could cause the urinary
frequency, were not given as an medical order to any patients. The other
possible reason of storage symptoms were the psychogenic LUTS or
overactive bladder described by Sakakibara et al (13). It was found that
the patients under the depressive condition could complain about the
voiding symptoms, so infected with COVID-19, hospitalized and the fear
of death could cause depressive moods to all patients. Also, we found
that stress incontinence was higher during the active infection period
rather than before and after the illness for the first time in the
literature. This result could be explained that the cough is one of the
main symptoms of COVID-19, so the increased cough could be expected to
cause this incontinence. With the recovery from COVID-19, the cough
would be less and so the stress incontinence would be detected less as a
result.
The retrospective design with a small number of participants and the
time of questionnaire completion are the major limitations of the study.
Another limitation was that there were no urine biochemical results,
voiding diary datas or uroflowmetry of the patients because the
clinicians were not aware of the importance of urine results in the
early days of the pandemic. The last limitation was there was no control
group to compare the incidence of the symptoms.
In conclusion, we have tried to show the urinary symptoms of COVID-19
patients with validated tools for the first time in the literature.
According to our results, LUTS, especially storage symptoms, might be
one of the early symptoms of COVID-19 and the clinicians should evaluate
LUTS with other known symptoms of the virus when a patient is suspected
of having COVID-19.