COVID-19 pandemic has spread all over the world. The pandemic has been also similar in Japan. At present, declaration of a state of COVID-19 emergency has been issued three times in Japan. The aim of the present study is to investigate whether lifestyle change associated with a declaration of a state of COVID-19 emergency in Japan led to the exacerbation of psychological stress, lower urinary tract symptom (LUTS) and lower urinary tract dysfunction (LUTD) for the outpatients with LUTS. In addition, whether the aggravation of psychological stress induced by the declaration might lead to the aggravation of LUTS was investigated in the present study.

The subjects were 104 outpatients with LUTS who visited our hospital during the first declaration of a state of COVID-19 emergency in Japan (April 7, 2020-May 31, 2020). Psychological stress was evaluated by the Stress Response Scale-18 (SRS-18) and weight changes. Furthermore, the contents of the SRS-18 question were classified into three systems: anxiety / depression, moody / anger, and lethargy.LUTS was evaluated by International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS). LUTD was evaluated by the post-voided residual urine volume. Each parameter was evaluated before, during and after the period of the declaration. In addition, degree of the severity of LUTS before, during and after declaration were investigated between the patients with the aggravation of psychological stress (psychological stress aggravation (+) group) and without the aggravation of psychological stress (psychological stress aggravation (-) group).

The average age in the present cohort was 74 years (18-93 years), with 83 males and 21 females. The present cohort was consisted of 57 patients with benign prostatic hyperplasia (BPH), 15 patients with overactive bladder (OAB), 9 patients with neurogenic bladder (NB), 15 patients with BPH + OAB, 3 patients with BPH + NB, and 5 other cases. The psychological  stress indexes evaluated by SRS- 18 and bodyweight have not significantly changed among before, during and after the declaration (SRS-18 total score:7.1±7.9、8.6±8.9、9.5±10.1, P = 0.20, and Body weight:62.1±11.2kg、63.6±11.2kg、62.9±10.9kg, P=0.67, respectively). In addition, the psychological stress indexes of each subscores were compared, but no significant differences were obserbed among each subscores (anxiety / depression: P=0.61, moody / anger: P=0.83, and lethargy: P=0.24, respectively). LUTS evaluated by IPSS and OABSS have not significantly changed before, during, after the declaration (IPSS: 12.7±7.3、13.4±7.0、13.0±7.2(P=0.82), and OABSS: 4.9±2.9、4.8±3.0、4.6±2.8(P=0.78), respectively). Post-voided residual urine volume has also not significantly changed (41.8±49.6ml、71.5±88.4ml、65.1±77.4ml ,P=0.24). However, the change ratio of IPSS voiding symptom subscore from before the declaration to during declaration significantly more worsened in the anxiety / depression stress aggravation (+) group than in the anxiety / depression stress aggravation (-) group (61.9 ±135.67%, 4.2 ±31.22%, respectively, P = 0.002, Figure 1). The change ratio of IPSS storage symptom subscore from before the declaration to during declaration also significantly more worsened in the moody / angry stress aggravation (+) group than in the in the moody / angry stress aggravation (-) group (38.8%± 73.4%, 7.3 ± 14.3%, respectively, P = 0.03, Figure 2). In addition, there were no significant differences in the ratio of OABSS change rate and residual urine volume between the aggravation (+) group and aggravation (-) group.

Outpatients with LUTS did not show a significant exacerbation of psychological stress and LUTS under the declaration of a state of COVID-19 emergency in Japan. On the other hand, because aggravation of LUTS was observed only in the patients with aggravation of psychological stress in the present study.

Exacerbation of psychological stress induced by COVID-19 pandemic might lead to the significant exacerbation of LUTS in the outpatients with LUTS.