Hypothesis / aims of study
Emerging evidence suggests that COVID-19 may induce new-onset or exacerbate pre-existing lower urinary tract symptoms (LUTS) [1-3]. This study aimed to assess the prevalence and progression of LUTS during and after acute COVID-19, and to evaluate the influence of comorbidities, disease severity, and vaccination status on LUTS.
Study design, materials and methods
In this prospective cohort study, adults hospitalized with COVID-19 between July 2021 and March 2022 were assessed using the International Prostatic Symptom Score (IPSS), the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and the ICIQ – Urinary Incontinence Short Form (ICIQ-UI SF) during hospitalization, and at 1 and 3 months post-discharge. Clinical and vaccination data were collected.
On the IPSS, symptoms were considered present if they occurred less than half the time or more. Quality of life (QoL) related to LUTS was evaluated using the IPSS QoL question, with impairment defined as a score ≥4 (“mostly dissatisfied” or worse). On the ICIQ-OAB, those with a total score ≥3 who reported urgency and/or urgency urinary incontinence (UUI) were identified as having OAB.
We assessed whether comorbidities, COVID-19 severity, and vaccination status were associated with the presence and severity of LUTS.
Patients were asked whether they had LUTS prior to COVID-19. Those reporting previous symptoms were queried about whether their symptoms had worsened, improved or remained unchanged.
Results
A total of 168 patients (median age 54, 53% male) were enrolled; 151 were contacted at one month and 137 completed 3-month follow-up. 96 participants (57.1%) were fully vaccinated at enrollment. Men and women were comparable in terms of comorbidities, COVID-19 severity, and vaccination status.
Moderate to severe LUTS were present in 31.0% during hospitalization. Nocturia (53.6%), urgency (43.5%), and increased frequency (36.9%) were the most common symptoms. Women had significantly higher rates of urgency (p=0.008), urgency incontinence (p=0.006), and stress incontinence (p<0.001). Overall, 36.7% of participants met the criteria for OAB (48.1% of women and 27.0% of men; p= 0.005).
LUTS improved over time, with a 50% reduction in moderate to severe symptoms, though statistical significance was not consistently reached (Table 1).
Pre-existing LUTS were reported by 21.4% of participants, with no gender difference. Among them, 69.4% noted no change during acute illness, 19.4% reported worsening, and 11.1% improvement. Of those with moderate to severe LUTS, 57.7% had prior symptoms, of which 23.3% reported worsening during COVID-19.
Pre-existing conditions and parameters of COVID-19 severity showed no correlation with the prevalence of LUTS during acute illness
Fully vaccinated individuals had a seven-fold increased risk of presenting moderate to severe LUTS at baseline (OR 6.77, 95% CI 2.90–14.64; p<0.001), and continued to show an elevated risk at three months post-discharge (OR 2.44, 95% CI 1.03–5.80; p=0.043). Patients who received the BBIBP-CorV (an inactivated-virus vaccine) were 2.23 times more likely to develop moderate to severe LUTS, with an adjusted OR of 10.56 (95% CI 4.13-26.9), while those who received mRNA vaccines had an adjusted OR of 4.72 (95% CI 1.84-12.03); p<0.001 (Figure 2).
Interpretation of results
LUTS, particularly storage symptoms, are common in the acute phase of COVID-19. Symptoms generally improve over time, with meaningful clinical recovery. LUTS may be newly-onset or worsened during illness, indicating a likely relationship with COVID-19. Vaccination, especially with inactivated-virus vaccines, was associated with increased risk of LUTS.