Post-acute sequelae of SARS-CoV-2 infection, or long COVID-19, significantly burden healthcare systems. Among these sequelae, lower urinary tract symptoms (LUTS), may arise de novo or worsen pre-existing conditions. This study aimed to assess the prevalence of LUTS in moderate-to-severe COVID-19 survivors and their association with other long COVID-19 symptoms and conditions.

In this prospective cohort study, patients hospitalized during the first COVID-19 wave in 2020 were reassessed three years post-discharge. Demographic data, including gender, age, and current comorbidities, were collected. LUTS were evaluated using the International Prostate Symptom Score (IPSS), with scores >7 indicating moderate-to-severe LUTS. Quality of life (QoL) impairment due to LUTS was identified for patients who reported being "mostly dissatisfied" or worse on the IPSS QoL question. Urinary incontinence was assessed with the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF). General health and potential COVID-19 sequelae were evaluated using the Post-COVID Functional Status (PCFS) scale, the Modified Independence Function (MIF) score, and the Modified Medical Research Council (mMRC) Dyspnea Scale.

Among the 516 patients (52.7% male, median age 59 [47-68]), diabetes (39.7%) and hypertension (53.7%) were common. Moderate to severe LUTS affected 36.2% (187 patients), with nocturia (55.7%) and urgency (24.4%) as the most prevalent symptoms; urgency was the only symptom at the IPSS that affected women (30.3%) and men (19.1%) differently (p=0.003). LUTS impacted QoL in 23.1% (119 patients), with no significant gender difference (p=0.16). Moderate to very severe urinary incontinence was found in 30.8% (20.2% of men, 38.2% of women, p<0.001). Functional limitations (PCFS), need for assistance (MIF score), dyspnea on exertion, and diabetes were present in 25.2%, 3.9%, 34.5%, and 39.7% of patients, respectively, and were all significantly associated with higher IPSS scores (p < 0.001) (Mann-Whitney U test).

Our study reveals a significant 36.2% prevalence of moderate to severe LUTS among COVID-19 survivors three years post-hospitalization, with nocturia and urgency as predominant symptoms. The strong correlation between LUTS and other long COVID-19 manifestations suggests a potential overlap in risk factors for severe COVID-19 and persistent LUTS, underscoring the complex, multifactorial etiology of post-COVID urological sequelae. Notable gender disparities in urgency and incontinence highlight the need for tailored management approaches. Furthermore, the impact of LUTS on quality of life in 23.1% of patients emphasizes its substantial burden, reinforcing the importance of comprehensive, multidisciplinary follow-up care to address the broader health implications for COVID-19 survivors.

This study reveals a high prevalence of LUTS among survivors of moderate-to-severe COVID- 19 three years post-hospitalization, with significant QoL impairments, particularly due to nocturia, urgency, and urinary incontinence. LUTS were closely linked to worse overall health status, reduced functional independence, and comorbid conditions. These findings highlight the need for long-term follow-up and individualized management of urinary symptoms in post- COVID care to improve QoL and support recovery in this population. Future research should investigate the mechanisms linking SARS-CoV-2 infection to persistent urological symptoms and develop targeted, gender-specific interventions.