New-Onset Bladder Symptoms in Discharged COVID Patients

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New-onset bladder symptoms can affect men and women who have been hospitalized with COVID-19, according to a case series presented at the American Urological Association (AUA) 2021 Annual Meeting.

Many COVID-19 patients discharged from the hospital have reported severe first-time genitourinary symptoms, including increased frequency, urgency, and nocturia that can cause patients to wake up five time a night, Michael B. Chancellor, MD, a urologist at the Beaumont Health System in Royal Oak, Michigan, said during a press briefing.

"We were the first US group to identify severe and bothersome de novo genitourinary symptoms in patients with confirmed SARS-CoV-2 infection, termed COVID-19 associate cystitis (CAC). We then sought to determine if this was associated with pro-inflammatory cytokines in the urine of patients," he and his colleagues write in their abstract.

For their study, the researchers compared 53 patients who had been discharged in recent weeks after a COVID-19 hospitalization and were reporting new-onset urinary symptoms (average age, 65 years) with 12 asymptomatic control subjects.

The majority of participants reporting bladder symptoms had no evidence of SARS-CoV-2 in their urine.

However, Luminex assays showed that levels of inflammatory cytokines — including growth-regulated oncogene-alpha, interleukin-6, interferon-gamma–inducible protein 10, and C-reactive protein — were significantly higher in urine samples from COVID-19 patients, especially those with CAC, than from control subjects.

"That was very surprising," Chancellor said, adding that it could indicate long COVID. "We really need to follow these patients to see if COVID-associated cystitis will stay" with them.

Such tracking shouldn't be too onerous. "The nice thing with urine is that people can collect it at home and mail it into the research laboratory on a regular basis," he told Medscape Medical News.

For men and women with COVID-19, the average total symptom score on the Urology Care Foundation Overactive Bladder (OAB) Assessment Tool was 18 (range, 4 - 21), and the average total quality-of-life score was 19 (range, 8 - 24), Chancellor reported. Higher scores on these tools reflect a worse quality of life.

An Inflammatory Problem?

Suzette Sutherland This study helps demonstrate that COVID-19 is a systemic problem, said Suzette E. Sutherland, MD, MS, director of female urology, director of the UW Medicine Pelvic Health Center, and associate professor at the University of Washington School of Medicine in Seattle. Scientists originally thought COVID-19 was a respiratory disease, but eventually recognized that it affects all systems, including the urinary system, she explained. Sutherland said she has seen new or worsening bladder symptoms in her large practice. Findings such as these should inform discussions that urologists and primary care physicians have with their patients when OAB issues and COVID-19 intersect, she told Medscape Medical News.

It is still unclear, though, whether OAB symptoms or exacerbations will fade with time after COVID-19 recovery.

And there are still questions about treatment options for patients who do not have virus in their urine but do have elevated levels of pro-inflammatory markers.

OAB treatments aren't as much "geared toward helping an inflammatory response" as they are to getting "the bladder muscles to calm down," she noted. "If we think it's more an inflammatory problem," maybe these patients should be treated aggressively with anti-inflammatories — whether steroidal or nonsteroidal — "to get that inflammatory response under control," she suggested.

Chancellor and Sutherland have disclosed no relevant financial relationships.

American Urological Association (AUA) 2021 Annual Meeting: Abstract MP29-15. Presented September 10, 2021.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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Cite this: New-Onset Bladder Symptoms in Discharged COVID Patients - Medscape - Sep 10, 2021.