Long COVID and COVID-19-associated cystitis (CAC)

Prospective follow-up of overactive bladder symptoms in patients with prior SARS-CoV-2 infection

PURPOSE

SARS-CoV-2 infection can result in genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure. In this study, we followed the progression of overactive bladder (OAB) symptoms in patients that reported new or worsening OAB symptoms after coronavirus disease-19 (COVID-19) diagnosis.

MATERIALS AND METHODS

Individuals from a COVID-19 serology study were invited to participate in a follow-up study. Respondents were divided into three groups based on prior COVID-19 testing. Patients scored symptoms retrospectively before the pandemic, at study onset, and prospectively during 12-month follow-up. Genitourinary symptoms were assessed using international consultation on incontinence questionaire for OAB (ICIQ-OAB). Change in ICIQ-OAB scores from baseline were calculated. The minimal important difference of one on ICIQ-OAB is considered a significant change.

RESULTS

26.0% of participants previously had positive COVID polymerase chain reaction (PCR) test (PCR+), 5.6% a positive serology test only (Ser+), and 65.5% were COVID naïve (COVID-). 23.8% of participants reported a significant increase in ICIQ-OAB score at study onset compared to prepandemic. ICIQ-OAB scores were similar at prepandemic but significantly higher at study start (p < 0.001) in PCR+ group. During follow-up, change in ICIQ-OAB scores from baseline remained unchanged for COVID- group, but gradually reduced for PCR+, reaching similar levels as COVID- group by 12 months. By 12 months, 71.4% of PCR+, 42.9% of Ser+, and 68.8% of COVID- participants still reported significant increase in ICIQ-OAB scores.

CONCLUSIONS

Most COVID-19 patients experienced return of symptoms to baseline, indicative of the potential resolution of COVID-associated cystitis. A subset of cases did not, raising questions about the underlying factors contributing to this outcome. Additional research is needed to assess long COVID on urological health.

Does COVID-19 cause or worsen LUT dysfunction, what are the mechanisms and possible treatments? ICI-RS 2023

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) and produced a worldwide pandemic in 2020. There have been 770,875,433 confirmed cases and 6,959,316 attributed deaths worldwide until September 19, 2023. The virus can also affect the lower urinary tract (LUT) leading to bladder inflammation and producing lower urinary tract symptoms (LUTS) in both the acute and chronic phases of disease.

METHODS

At the 2023 meeting of the International Consultation on Incontinence-Research Society (ICI-RS), the literature relating to COVID-19 and bladder dysfunction was reviewed. The LUTS reported, as well as the pathophysiology of these bladder symptoms, were the subject of considerable discussion. A number of different topics were discussed including lower LUTS reported in COVID-19, how SARS-CoV-2 may infect and affect the urinary tract, and proposed mechanisms for how viral infection result in new, worsened, and in some persisting LUTS.

CONCLUSIONS

The workshop discussed the interaction between the virus and the immune system, covering current evidence supporting theories underlying the causes of acute and chronic LUTS related to COVID-19 infection. Research questions for further investigation were suggested and identified.

Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report

BACKGROUND

While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spinal cord infarction or ischemia has been extremely rare. Findings of long coronavirus disease (COVID) in this select population have not been studied.

CASE SUMMARY

We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction, attributed to acute infection with SARS-CoV-2. Diagnostic work up confirmed a T3 complete (ASIA impairment Scale A) paraplegia resulting from a thrombotic infarct. Her reported myalgias, neuropathic pain, spasticity, bladder spasms, and urinary tract infections exceeded the frequency and severity of many spinal cord injury (SCI) individuals of similar age and degree of neurologic impairment. In her first year after contracting COVID-19, she underwent 2 separate inpatient rehabilitation courses, but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled pain. Yet other complications of complete non-traumatic SCI (NTSCI), including neurogenic bowel and temperature hypersensitivity, were mild, and pressure injuries were absent. She has now transitioned from the acute to chronic phase of spinal cord injury care, with subsequent development of post-acute sequelae of SARS-CoV-2 infection (PASC).

CONCLUSION

This individual experienced significant challenges with the combined effects of acute T3 NTSCI and acute COVID-19, with subsequent progression to PASC.

Prolonged impacts of COVID-19-associated cystitis: A study on long-term consequences

BACKGROUND

The Coronavirus Disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 virus is an international health concern with substantial morbidity and mortality. COVID-associated cystitis (CAC), presents as new onset or exacerbated urinary symptoms, resembling overactive bladder (OAB) symptoms.

AIM

To examines the long-term outcomes of patients with CAC in the context of Long COVID.

METHODS

A cohort of 350 patients admitted to Detroit Hospitals with COVID-19 between May and December 2020, displaying CAC symptoms following discharge, was prospectively followed. Initial urologic evaluations occurred at 10-14 wk and were repeated at 21-28 mo post-discharge. Symptoms were managed conservatively, employing behavioral modifications and standard OAB medications. Participants completed surveys assessing urinary symptoms and quality of life (QoL) at both time points. The primary outcome was the Urology Care Foundation Overactive Bladder Assessment Tool.

RESULTS

87% of the final cohort (n = 310) reported symptom improvement at 21-28 mo post-discharge. Patients with new onset CAC symptoms showed a median decrease of 9-10 points in OAB and QoL scores, while those with existing symptoms experienced a decrease of 6 points. Overall, 95.4% of patients with new onset symptoms reported symptom improvement at follow-up, contrasting with 60.7% among those with existing symptoms.

CONCLUSION

This study presents the first long-term follow-up of adult patients with CAC, revealing a promising prognosis with conservative management measures in the context of Long COVID. These findings provide reassurance to patients regarding symptom resolution and underscore the need for further research into this evolving aspect of COVID-19's impact on urological health.

COVID-associated cystitis: the culprit behind the bladder woes post-COVID infection? A review

PURPOSE

SARS-CoV-2 had a significant impact on public health since its declaration as a pandemic. It is linked to a high rate of multiple organ dysfunction syndrome (MODS) and a slew of long-term symptoms that are yet to be thoroughly investigated. Among these, genitourinary symptoms of an overactive bladder (increased frequency, urgency, and nocturia) have recently been identified and labeled as COVID-associated cystitis (CAC). This current research is performed to review this phenomenon.

METHODS

A literature search was performed in MEDLINE, Cochrane, and Google Scholar databases and 185 articles were obtained in total, including reviews and trials involving CAC, which were screened using various methods, and 42 articles were gathered for the review.

RESULTS

Among its multitude of symptoms, overactive bladder (OAB) leads to poorer outcomes. The inflammatory mediator-based theory and the ACE-2 receptor-based theory are two probable theories for how it harms the bladder urothelium. The expression of ACE-2 receptors during the pathogenesis of CAC warrants further investigation as ACE modulation may reveal more information about COVID-19 complications. Other comorbidities, immunocompromised patients, or patients with a history of urinary tract infections can also exacerbate this condition.

CONCLUSION

The scarce literature collected related to CAC gives us an insight into the symptomatology, pathophysiology, and possible treatment plans. Treatment choices are diverse among COVID-19-afflicted and unaffected patients for treating urinary symptoms which highlights the importance to distinguish between the two. CAC shows greater prevalence and morbidity when linked to other conditions, thereby warranting future developments in it.

The effectiveness of COVID deaths to COVID policies: A robust conditional approach

This paper examines the effectiveness of four major COVID-19 social distancing policies, (i) shelter-in-place orders (SIPO), (ii) non-essential business closures, (iii) mandatory quarantine for travelers, and (iv) bans on large gatherings, on both COVID cases and COVID deaths. Results indicate that states are highly ineffective in producing the fraction of the population that does not have COVID-19 or the fraction of the population that does not die from COVID-19. We find that having any form of social distancing policies increases the fraction of the population not considered a positive COVID-19 case by 23.5 percentage points. Results also show that having any of the four major social distancing policies reduces the fraction of the population who has died of COVID-19 by 1.3 percentage points between March 1, 2020 and September 1, 2020; during the first 100 days, effectiveness would improve by 2.1 percentage points. Evidence suggests that there is no effective uniform national COVID-19 social distancing policy. Furthermore, conditional efficiency regressions after 100 days suggest that behavioral noncompliance and premature expiration of social distancing policies both negatively impact effectiveness. Partial regression plots suggest that bans on large gatherings and the closure of non-essential businesses were the two most impactful COVID-19 social distancing policies.

Clinico-epidemiological profile and outcome of infected health care workers during the three consecutive waves of COVID-19 pandemic: a longitudinal cohort study

Background

Health care workers are considered as high-risk population, who deal with many unknown, undiagnosed, and subclinical infectious diseases in their daily life. Currently, the COVID-19 pandemic posed as an add-on burden for these frontline workers in all aspects. Although, many adverse physical and mental effects of pandemic among health care workers (HCWs) were discussed worldwide, a long-term study for delayed complications needed to be explored.

Aim

The study evaluates and compares three waves of the pandemic in various aspects such as the incidence, prevalence, severity, risk factors, and variations in the pattern of COVID-19 infection, impact of vaccination, and post-infection complications among the HCWs.

Methodology

A longitudinal observational study was carried out over a period of 2 years and another 6 months for follow-up. The study included all HCWs who tested positive in any one wave of COVID-19 pandemic with any one of the confirmed COVID-19 test. Each COVID-19-affected HCW was followed up through telephone calls and direct interviews conducted at the study site. Admission details and other background details of the study population were collected from the hospital records.

Results

A total of 968 HCWs were COVID-19 positive in any of the three waves, and highest incidence (53.00%) was caused by the Omicron variant. High severity and hospitalization was observed in the first wave (no vaccination) and fully immunized personnel were found to be out of danger of being hospitalized during all succeeding waves (chi-square value: 87.04, p < 0.05). Predictors such as female gender, occupational exposure, and comorbid status were identified as possible risk factors for infection. A total of 70 HCWs reported with 104 complications, of which chronic diseases such as new onset of diabetes (n = 3), cardiovascular events (n = 8), worsening of preexisting comorbidities (n = 8), etc. were found out.

Conclusions

This study proves the benefit of being immunized rather than the risk of being infected. This study documents that immunization impacted complication and hospitalization rates of COVID-19 infection. This evidence may help in tackling vaccine hesitancy across the nations.

Genitourinary tract symptoms in patients admitted with COVID-19: Exploring changes in frequency by determinants and pandemic waves

Background

Urothelial cells exhibit increased expression of angiotensin-converting enzyme-2 receptor, which is the binding site of severe acute respiratory syndrome coronavirus 2 to cells. The frequency and distribution of genitourinary tract symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19) is unknown.

Objective

We explored trends in genitourinary tract symptoms by gender and each of six pandemic waves in patients admitted for COVID-19, and related them with severity, death and length of hospitalization.

Design Setting and Participants

A retrospective study took place in our institution of COVID-19 admitted patients. Only patients with RT-PCR or antigen test confirmed SARS-CoV-2 infection were included. Demographic, clinical, and genitourinary symptoms were explored.

Outcome Measurements and Statistical Analysis

COVID-19 patients with genitourinary tract symptoms were compared with those without. Statistical comparisons were conducted by parametric and nonparametric tests for quantitative variables, and χ 2 test for qualitative variables.

Results and limitations

Out of a total of 4,661 COVID-19 patients, genitourinary symptoms were found in 21,1%. These symptoms were more frequent in patients admitted for longer than 30 days, except for urinary incontinence (UI) and erectile dysfunction (ED). Acute kidney injury (AKI) and urinary tract infections (UTI) had a higher presence in the 5^th (16.7%; 12.8% respectively) and 3^rd wave (13.3%; 12.6% respectively). Genitourinary symptoms were higher for those patients admitted in critical care units. Frequency of AKI, UI, UTI and acute urinary retention (AUR) were higher for patients who were finally deceased (26.2%; 3.5%; 13.6% and 3.6% respectively).

Conclusions

A high frequency of genitourinary symptoms in patients admitted for COVID-19 was observed, whose frequency and distribution varied according to pandemic waves. Specific genitourinary conditions were associated with worse outcomes and poorer prognosis.

Prescription of Choreito, a Japanese Kampo Medicine, with Antimicrobials for Treatment of Acute Cystitis: A Retrospective Cohort Study

Choreito, a Japanese Kampo medicine, is used to treat Japanese female patients for the quick relief of inflammatory symptoms associated with acute cystitis. We evaluated whether Choreito is effective in reducing antibiotic use and the number of clinic visits for these patients. Females aged 18-49 years who had acute cystitis for the first time, with no history of medical insurance use within 90 days prior to their visit, and no hospitalizations within the 30 days after their first visit were identified from the JMDC Claims Database between April 2018 and March 2021. For the 30 days after their first visit, patients who were given their first antimicrobial prescriptions with or without Choreito were compared regarding (i) the number of clinic visits, (ii) total antimicrobial prescription days, and (iii) the number of antimicrobial prescriptions adjusted for their age, Charlson comorbidity index, and the COVID-19 pandemic period (after April 2020). For the 319 and 8515 patients with or without a Choreito prescription, respectively, multivariable Poisson regression analyses showed that Choreito was significantly associated with a 5% shortening of a patient's total antimicrobial prescription days (Beta, 0.950; p = 0.038), whereas no significant difference was observed in the number of clinic visits and antimicrobial prescriptions (p = 0.624 and p = 0.732, respectively). The prescription of Choreito in combination with antimicrobials was associated with a slight reduction in total antimicrobial use for acute cystitis among females.

Impact of COVID-19 on male urogenital health: Success of vaccines

Throughout 2021, the scientific and medical communities were concentrated on dealing with the acute morbidity and mortality induced by the COVID-19 pandemic due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We reviewed the present data for adverse effects of COVID-19 on the different parts of the male urogenital system during the dynamic situation of the COVID-19 pandemic. With the approval of COVID-19 vaccinations, there is a ray of hope at the end of this dark tunnel and a chance to look ahead for the management of long-term consequences in males with urogenital illness. A multidisciplinary investigation of these cases could provide information for establishing and optimizing treatment protocols.

The Pathophysiology of Long COVID throughout the Renin-Angiotensin System

COVID-19 has expanded across the world since its discovery in Wuhan (China) and has had a significant impact on people's lives and health. Long COVID is a term coined by the World Health Organization (WHO) to describe a variety of persistent symptoms after acute SARS-CoV-2 infection. Long COVID has been demonstrated to affect various SARS-CoV-2-infected persons, independently of the acute disease severity. The symptoms of long COVID, like acute COVID-19, consist in the set of damage to various organs and systems such as the respiratory, cardiovascular, neurological, endocrine, urinary, and immune systems. Fatigue, dyspnea, cardiac abnormalities, cognitive and attention impairments, sleep disturbances, post-traumatic stress disorder, muscle pain, concentration problems, and headache were all reported as symptoms of long COVID. At the molecular level, the renin-angiotensin system (RAS) is heavily involved in the pathogenesis of this illness, much as it is in the acute phase of the viral infection. In this review, we summarize the impact of long COVID on several organs and tissues, with a special focus on the significance of the RAS in the disease pathogenesis. Long COVID risk factors and potential therapy approaches are also explored.

Covid-19, pelvic health, and women's voices: A descriptive study

Objective

To examine how the pandemic affected women with pelvic dysfunction.

Methods

A Survey Monkey™ online questionnaire on how the pandemic and Covid-19 infection affected women's pelvic problems, exercise, and weight. A free text box captured their comments.

Results

Six hundred and forty-seven women took part. Bladder control 265 (41%), prolapse 240 (37%), pelvic pain 40 (6%), sexual dysfunction 27 (4%), faecal incontinence 19 (3%) and other symptoms 56 (9%) were women's main pelvic problems. Symptoms were unchanged for 331 (51%), worse for 243 (38%), and improved for 60 (10%). Weight was gained by 290 (45%), unchanged by 243 (38%), and lost by 114 (17%). Exercise levels were unchanged, worse, or better in 33% each. Access to medical appointments and date for surgery were difficult for 235 (36.5%) and 38 (6%) women respectively. Sixty-six (10.3%) women reported Covid-19 infection: the distribution of pelvic problems and changes through the pandemic, weight and exercise patterns, and difficulty accessing a date for surgery or healthcare were similar to those not contracting infection. Sexual dysfunction was the main new or worsening problem, featuring 13 women (18%). Seventy women - 16 postnatal, and 54 with a pre-existing pelvic problem commented. Five core themes were identified. Difficulty accessing healthcare review, mental health impact and physiotherapy services especially affected delivered women: lifestyle alterations and conservative treatment tools were prominent in women with a pre-existing problem.

Conclusions

Pelvic floor dysfunction adversely affected women's mental health in the pandemic through limiting their ability to exercise. Furthermore, the pandemic exposed the fact that female pelvic health services are not readily available to those in need: many women particularly postnatally received no care. Sexual dysfunction was a feature of recovery from Covid infection in this study.