COVID-19 has been shown to cause lower urinary tract symptoms (LUTS), but the prevalence and long-term outcomes of these symptoms are not known. In this observational study, we evaluated the prevalence of LUTS in surviving adult patients (>18 years of age) with laboratory-confirmed diagnosis of COVID-19 six months after hospital discharge from a large academic health center in São Paulo, Brazil. The primary aim of this study was to evaluate the prevalence of LUTS in men and women six months after being treated as inpatients for COVID-19. The secondary objective was to evaluate the impact of clinical parameters of COVID-19 severity and comorbidities on the prevalence of LUTS.

In this observational study, 255 adult subjects (138 men and 117 women) with laboratory-confirmed diagnosis of COVID-19 who had been treated as inpatients at a single academic institution were invited to undergo a series of multidisciplinary assessments six months after discharge. Sociodemographic data, comorbidities and clinical parameters of COVID-19 severity were analysed. Evaluations included multi-domain questionnaires applied by medical research staff and self-report scales. LUTS were assessed using the International Prostate Symptom Score (IPSS) questionnaire. Participants were asked to rate how often they experienced individual LUTS (frequency, incomplete emptying, intermittency, urgency, slow stream, straining to void and nocturia) during the past month. The study was approved by a local ethics committee and was performed in compliance with Good Clinical Practice and in accordance with the Declaration of Helsinki. Informed consent was provided by all participants.

The median age of the participants (n=255) was 57.3 [43.9 – 66.7] years, and 54% were male. Table 1 shows sociodemographic data, comorbidities and parameters of COVID-19 severity. Male and female patients were comparable in terms of age distribution, educational level, physical activity, general health status and comorbidities. COVID-19 severity parameters were also similar between men and women. 
Prevalence of LUTS: 89.4% of the participants (88.4% of men and 90.6% of women) had at least one of the seven specific symptoms evaluated by the IPSS. Symptoms with the highest overall prevalence were nocturia (62.0%) and increased urinary frequency (50.2%), followed by urgency (42.0%), incomplete emptying (39.2%), slow stream (29.8%), intermittency (29.4%) and straining (20.0%). The most prevalent ICS symptom category in both men and women was storage (69.6% and 80.3%, respectively). Voiding symptoms were more common in men (44.2% in men and 50.2% in women). Overall, LUTS had a significant impact on the quality of life of 23.6% of the participants, who reported they would be "mostly dissatisfied," "unhappy," or consider it "terrible" to spend the rest of their life with their urinary condition as it is currently.  Of those with moderate to severe symptoms, quality of life was detrimentally affected in 46.3%.  The prevalence of moderate to severe LUTS (IPSS ≥8) was 42.4%, increased with age and was similar between men and women (Figure 1). In univariate analysis, having hypertension was associated with an increased risk of having moderate to severe LUTS (OR:2.38 [1.9-3.9; P<0,001), as well as having diabetes (OR:1.38 [1.,2-1.83]; P=0,02). None of the other comorbidities and none of the clinical parameters of COVID-19 severity were associated with the risk of having moderate to severe LUTS.

Our study shows a high prevalence of LUTS among COVID-19 survivors, six months after hospital discharge. Storage symptoms are the most common, specially nocturia and increased urinary frequency. Hypertension and diabetes were associated with a higher risk of having moderate to severe LUTS. Clinical parameters of COVID-19 severity were not associated with the risk of having LUTS.

This was the first study to evaluate the prevalence and caracteristics of LUTS in the long term following hospitalization for the treatment of COVID-19. LUTS are highly prevalent and often bothersome among surviving men and women six months after hospitalization due to COVID-19. Storage symptoms are the most frequent category and specific symptoms were not sex-specific. Parameters associated with severity of COVID-19 were not linked with the prevalence of LUTS. Future studies should clarify the longer-term outcome of LUTS following COVID-19. Comprehensive assessment of LUTS and their effects may help ensure appropriate diagnosis and treatment in these patients.

Dhar, N., et al., De Novo Urinary Symptoms Associated With COVID-19: COVID-19-Associated Cystitis. Journal of Clinical Medicine Research, 2020. 12(10): p. 681-682.
Mumm, J.N., et al., Urinary Frequency as a Possibly Overlooked Symptom in COVID-19 Patients: Does SARS-CoV-2 Cause Viral Cystitis? Eur Urol, 2020. 78(4): p. 624-628.
Barry, M.J., et al., The American Urological Association symptom index for benign prostatic hyperplasia. The Journal of urology, 1992. 148(5): p. 1549-1557