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Patients with COVID-19 are experiencing new onset and worsening overactive bladder (OAB) symptoms resulting from cystitis, according to study results shared during the 2021 AUA Annual Meeting.1
These OAB systems, known as COVID-19–associated Cystitis (CAC), include increased urinary urgency, frequency, nocturia, and pain, with patients identifying nocturia as the most bothersome problem, according to lead study author Michael B. Chancellor, MD, a professor and director of neurourology at Beaumont Health System and Oakland University Beaumont School of Medicine, Royal Oak, Michigan.
Chancellor said that during the first wave of the pandemic (March-May 2020), he and his primary research collaborator Nivedita Dhar, MD, “began to notice we were getting consults for COVID 19–positive patients who, even after they recovered, were reporting new onset or worsening urinary symptoms. And we were wondering, could this be a new symptom manifestation of COVID-19? And what’s going to happen to these patients in the long-term?”
Chancellor, Dhar, and colleagues sought to at least start answering these questions with a small study that included 53 hospital discharged COVID-19 patients with normal renal function, as well as 12 asymptomatic controls. The patients completed the AUA Urology Care Foundation OAB AssessmentTool, which has a scale from 0 (no symptoms) to 25 (most severe symptoms).
Among patients with available demographic data, there were 12 females, 34 males, and 9 other/unmarked. The median age was 63.5 years (range, 47-82). There were 41 patients with new onset symptoms and 5 patients with worsening symptoms.
The median symptom score in patients with new OAB symptoms was 17.5 (range, 12-21), and the median QOL score was 19.3 (range, 16-21). In patients with worsening OAB symptoms, the median symptom score was 8 (range, 4-10) before COVID-19 and 19 (range, 17-21) after. The QOL scores in these patients were 9 (range, 8-10) and 20 (range, 19-20), respectively.
The investigators tested urine samples for COVID-19 using PCR and found that the majority of patients did not have the virus itself in their urine.
Seeking an alternative explanation for the CAC, the researchers used Luminex assays to examine the urine for pro-inflammatory cytokines. This analysis identified the proinflammatory cytokines IL-6 and IL-10, which are linked to the severe toxicity of cytokine storm in patients with COVID-19. Thus, Chancellor et al suggest these cytokines are causing the bladder inflammation leading to CAC.
In his concluding remarks, Chancellor said, “COVID-19 patients can develop de novo urinary symptoms, most commonly, an increase in urgency, frequency, and nocturia. COVID-19 patients, especially those with CAC, have increased inflammatory cytokines in the urine that may reflect the severity and duration of their disease.
“Moving forward, more research is needed to follow these patients long-term, because although for most patients with COVID19 [these urinary symptoms] get better, a percentage are long-haulers—they are persistent—and we need to try and help them with their bladder problems.”
1. Chancellor MB, Wills M, Timar R, et al. COVID-19 Associated Cystitis (CAC): increased urinary symptoms and biomarkers of inflammation in urine in patients with acute COVID-19. Presented at 2021 American Urological Association Annual Meeting; September 10-13, 2021; virtual. Abstract MP29-15.