Previous studies have reported a high prevalence of lower urinary tract symptoms (LUTS) following hospitalization for COVID-19. We aim to investigate whether the severity of COVID-19 infection is associated with the evolution of LUTS during follow-up.

This is a prospective cohort study conducted at a university hospital that served as a referral center for moderate to severe cases of COVID-19. The study was approved by the local ethics committee (approval number 4.270.242). After hospital discharge, patients were followed longitudinally using the International Prostate Symptom Score (IPSS). An increase or decrease in 4 points in the IPSS score was considered clinically relevant. We used the Chi-square test to assess the distribution of IPSS evolution (improvement, stability, or worsening). The Mann-Whitney U test was used to evaluate the association between disease severity and LUTS progression. A p-value < 0.05 was considered statistically significant.

A total of 166 patients participated in the study, with a mean age of 58.2 years (range: 22–99), of whom 90 (54.2%) were men. Comorbidities were present in 133 participants (80.1%), with hypertension being the most prevalent condition (50.6%). After a 3-year follow-up, 74 patients reported no change in their IPSS scores, 55 experienced symptom improvement, and 37 reported worsening, as reflected by increased scores. An apparent, although statistically non-significant, association was observed between changes in IPSS scores and the severity of the initial COVID-19 hospitalization. Based on the WHO severity classification, 16 patients were categorized as grade I, 61 as grade II, 9 as grade III, and 80 as grade IV. The proportion of patients reporting improvement in each group was 31.2%, 27.8%, 22.2%, and 17.1%, respectively. Although not statistically significant, the evaluation of the self-reported quality of life in the IPSS questionnaire demonstrated that most participants identified an improved or unchaged status, further proving that the larger proportion of patients recovered or stabilized over time.

Our finding that changes in IPSS scores over a three-year period tended to correlate with the severity of the initial COVID-19 infection - despite not reaching statistical significance - is consistent with existing literature. Previous studies have demonstrated that more severe acute COVID-19 is associated with greater urinary symptom burden in the post-acute phase, although many patients experience gradual improvement over time, particularly with conservative management. These observations support the hypothesis that SARS-CoV-2 infection may contribute to long-term urological sequelae. Moreover, they suggest that the trajectory of symptom resolution may be influenced by factors such as the initial disease severity, baseline urinary function, and individual host characteristics. Our study included only patients who completed the questionnaires, resulting in a smaller population for analysis, compromising better interpretation of the outcomes.

Although no statistically significant association was observed, the apparent correlation between COVID-19 severity and long-term urinary outcomes highlights the need for continued surveillance and individualized follow-up. Further research is warranted to elucidate the underlying mechanisms and to identify patients at higher risk for long-term urological sequelae.

Oliveira AC, Lima N, Martins JF, et al. Impact of COVID-19 on the practice of urology: a global perspective. Int Braz J Urol. 2021;47(6):1284-1295. doi:10.1590/S1677-5538.IBJU.2021.0251.