Published studies on the effect of COVID-19 on the urogenital tract often have a small sample size and, in some cases, reported heterogeneous results. At this point, transmembrane protease serine 2 (TMPRSS2) is responsible for the cleavage of spike proteins (defined as priming), which is required for fusion of cellular and viral membranes20 (Fig. SARS-CoV-2 might cause inflammatory cytokine storms, which lead to acute respiratory distress syndrome or multiple-organ failure and could be associated with disease severity48,49,50. Infect. Many of the reported symptoms of COVID-19 vaccination (LUTS, haematuria and urinary infection) have the same prevalence in vaccinated and unvaccinated individuals; thus, a causal attribution to the vaccination seems unlikely140. Results from autopsy studies on patients deceased of COVID-19-associated causes reported severe tissue alterations in various organs6,7. $('mega-back-specialties').on('click', function(e) { Thus, this method has been also discussed as a possible tool to evaluate hospital discharge of patients with COVID-19 (ref.59). -, Lee Y.W., Lim S.Y., Lee J.H., Lim J.S., Kim M., Kwon S., Joo J., Kwak S.H., Kim E.O., Jung J., et al. Calabrese, F. et al. Res. In another study, the average International Prostate Symptom Score (IPSS), which is used as a validated questionnaire to quantify lower urinary tract symptoms (LUTS)69, was assessed in patients with COVID-19 aged >50 years (n=62) in the acute stage of the disease and surveyed retrospectively for the time before COVID-19 infection70. $('.mega-back-button-specialties').on('click', function(e) { COVID-19-associated coagulopathy seems to be mediated by excessive inflammation, endothelial activation and injury, platelet activation, impaired or dysfunctional fibrinolysis and systemic hypercoagulability122; vascular endothelial cells are among the primary targets of SARS-CoV-2, and COVID-19 infection can result in endothelial damage and also in systemic vasculitis123. Modeling the contribution of male testosterone levels to the duration of positive COVID testing among hospitalized male COVID-19 patients. Gastroenterol. A bacterial urinary tract infection in these patients was excluded; therefore, the urinary symptoms were assumed to be caused by SARS-CoV-2, although no viral detection was conducted68. On this basis, cell types with >1% of ACE2+ cells were considered at a high risk of SARS-CoV-2 infection. Pan, X. W. et al. On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. and G.M. While there is a link between COVID-19 and new LUTS, the virus that causes COVID-19, SARS-CoV-2, may not be the direct cause in all cases. Kashi, A. H. et al. Spirito, L. et al. Cheng, Y. et al. Virchows Arch. The median age of the patients reporting urologic symptoms was 63 years (IQR 44-79, Range: 19-96) and 54% of the patients were female.Urologic symptoms reported after COVID-19 vaccination are extremely rare. Are sex disparities in COVID-19 a predictable outcome of failing mens health provision? Investigation of SARS-CoV-2 in semen samples and the effects of COVID-19 on male sexual health by using semen analysis and serum male hormone profile: a cross-sectional, pilot study. Giuseppe Magistro. In the wake of the pandemic: Preparing for Long COVID (World Health Organization, 2021). Urinary symptoms de novo or associated cystitis COVID-19 (CAC) develops against the background of a complete lack of data for the presence of a bacterial pathogen in the urine. $('.mega-back-button-mediaresources').on('click', function(e) { Aging https://doi.org/10.18632/aging.202224 (2020). Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? Mei, F. et al. & Zhu, D. Cyclophilin A and CD147: novel therapeutic targets for the treatment of COVID-19. 37, 271284 (2021). Semen impairment and occurrence of SARS-CoV-2 virus in semen after recovery from COVID-19. J. Infect. COVID-19 vaccine and booster recommendations may be updated as CDC continues to monitor the latest COVID-19 data. Tsai CH, Lee WC, Shen YC, Wang HJ, Chuang YC. Deidda, S. et al. Bladder infection: Causes, treatments, and remedies - Medical News Today However, opposite results were reported from a study including 121 men who recovered from COVID-19: at a 7-month follow-up time, 55% of men still suffered from hypogonadism (total testosterone <9.2 nmol/l)97. Biol. Farouk, S. S., Fiaccadori, E., Cravedi, P. & Campbell, K. N. COVID-19 and the kidney: what we think we know so far and what we dont. Nephrol. No detection of SARS-CoV-2 RNA on urethral swab in patients with positive nasopharyngeal swab. Zou, X. et al. In Sweden, the number of men diagnosed with prostate cancer decreased by one-third in spring 2020 compared with previous years, but no reduction in the number of curative treatments was observed150. $("mega-back-mediaresources .mega-sub-menu").show(); COVID-19 and Urinary Incontinence: What the Research Says - Healthline Severely low testosterone in males with COVID-19: a case-control study. The immunity someone gains from having an infection, called natural immunity, varies from person to person. Intern. Please enable it to take advantage of the complete set of features! 18, 223228 (2006). SARS-CoV-2 infection affects the lower urinary tract and male - PubMed Urinary frequency as a possibly overlooked symptom in COVID-19 patients: does SARS-CoV-2 cause viral cystitis? JAMA Oncol. AKI is a severe urological complication of COVID-19 accompanied by high mortality, which is hypothesized to be caused by a cytokine-storm-induced systemic inflammatory response and direct cytopathic effects. J. Bras. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. $(".mega-back-specialties .mega-sub-menu").hide(); Vasc. It is uncertain if everyone with long COVID will fully recover, though. In a cross-sectional testicular ultrasonography study, incidental epididymitis was found in 42% of patients with mild-to-moderate COVID-19, all of whom had no scrotal complaints and no clinical signs of orchitis82. 78, e40e41 (2020). Anal swab as a potentially optimal specimen for SARS-CoV-2 detection to evaluate hospital discharge of COVID-19 patients. Chapple CR, Drake MJ, Van Kerrebroeck P, Cardozo L, Drogendijk T, Klaver M, Van Charldorp K, Hakimi Z, Compion G. BJU Int. Lancet Oncol. Previous studies have found viral RNA in the urine of people with COVID-19, although this does not always correlate to symptoms. Patients with medical emergencies often avoid hospital emergency departments because of the fear of COVID-19 contagion143. Histopathology and ultrastructural findings of fatal COVID-19 infections on testis. However, to date, no clear proof is available to support the original hypothesis that high ACE2 expression levels increase the risk of viral invasion. Several agents disrupt the interaction between the S proteins and ACE2, such as ACE2 mimetics, therapeutic antibodies (targeting S protein) and vaccine-elicited antibodies (blocking the virus binding to ACE2). Iba, T., Connors, J. M. & Levy, J. H. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. Kidney J. Androgen signaling regulates SARS-CoV-2 receptor levels and is associated with severe COVID-19 symptoms in men. J. Clin. Short-term effects of COVID-19 on semen parameters: a multicenter study of 69 cases. Front. 2). Li, D., Jin, M., Bao, P., Zhao, W. & Zhang, S. Clinical characteristics and results of semen tests among men with coronavirus disease 2019. In urology, a dramatic decline in routine prostate cancer screening was observed147,148,149,150. You might have chronic, or recurrent, bladder infections if you have two or more bladder infections in six months or three or more infections in a year. Liu, W., Han, R., Wu, H. & Han, D. Viral threat to male fertility. 2023 Healthline Media UK Ltd, Brighton, UK. 202, 162192 (2020). In summary, thromboembolism is a frequent complication of COVID-19 (ref.118) and also affects organs of the genitourinary tract127,128,129,130,131,132. Appraising the contemporary evidence. Department of Urology, University of Texas Southwestern, Dallas TX. https://doi.org/10.3390/jcm7120549 (2018). However, COVID-19 has the potential to be a multisystem illness, meaning it can affect more than one system in the body at once. Characterising long COVID: a living systematic review. 93, 206222 (2021). 7, 100056 (2020). A new study published on the preprint server bioRxiv *, in June 2020, reports that the condition of overactive bladder (OAB) could be associated with a different route of infection by severe. The renin-angiotensin-aldosterone system and coronavirus disease 2019. Furthermore, thinning of seminiferous epithelium was observed in deceased patients with COVID-19, and the proportion of apoptotic cells in testes of these patients was significantly higher (2.95-fold, P=0.018) than the average of deceased men without COVID-19. However, the Omicron variant induces a considerably milder disease at the population level and has been shown to trigger cross-protective immunity towards the Delta variant135. Gupta, A. et al. Relat. jQuery(function($) { Annu. These observations could suggest either that the viral load of SARS-CoV-2 in the urogenital tract is low or that the viral excretion via the urogenital tract is highly restricted. 80, 607613 (2020). Dis. Extrapulmonary manifestations of COVID-19. Liu, X. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. The reported mortality in hospitalized patients with COVID-19 and AKI varies tremendously (3480%)36, but might still be considered substantially higher than the average mortality of all hospitalized patients with COVID-19 (including patients without AKI), reported to be between 9.3% and 19.7% in a cohort study including 503,409 patients38. . doi: 10.1002/jmv.26996. Med. Post, A. et al. Disclaimer. PDF Adverse events among children ages 5 -11 years after COVID-19 - CDC 2021;106:376381. Afshari, A., Janfeshan, S., Yaghobi, R., Roozbeh, J. Opin. Fan, C., Lu, W., Li, K., Ding, Y. Dhar, N. et al. According to a 2022 study, COVID-19 can affect the: It is unclear how many people have LUTS, but the researchers in this study found that the prevalence of urinary symptoms was relatively high.. Impaired spermatogenesis in COVID-19 patients. Results from a study including 41 hospitalized patients with COVID-19 showed higher plasma concentration of multiple cytokines, such as IL-2, IL-7, IL-10, granulocyte colony-stimulating factor (G-CSF) and tumour necrosis factor (TNF) in patients treated in the intensive care unit (ICU)51 than in patients in the non-ICU group48. In kidney epithelial cells, a novel route of viral invasion for SARS-CoV-2 mediated by the interaction of spike proteins with CD147 (a transmembrane glycoprotein also known as basigin) has been described56,57, suggesting that other ACE2-independent mechanisms of viral invasion in the kidney might exist and warrant further investigation. 26, 10171032 (2020). De Vincentiis, L., Carr, R. A., Mariani, M. P. & Ferrara, G. Cancer diagnostic rates during the 2020 lockdown, due to COVID-19 pandemic, compared with the 20182019: an audit study from cellular pathology. Priapism in a patient with coronavirus disease 2019 (COVID-19). Cureus 12, e10114 (2020). Find out about the COVID-19 vaccines, the benefits of COVID-19 vaccination and the possible side effects. Some side effects tied to COVID-19 that might play a role in an acute kidney injury include: Damage to kidney cells (or acute tubular . Cell Biol. Sci. Front. A multi-center retrospective cohort study defines the spectrum of kidney pathology in coronavirus 2019 disease (COVID-19). J. Trop. Nat. Med. Rev. The direct association between increased ACE2 levels and impairment of spermatogenesis supports the hypothesis that organs with high ACE2 levels are at a high risk of cell damage and suggests that the testes might be target organs of SARS-CoV-2. -. Research notes that COVID-19 appears to worsen existing OAB or causes new symptoms, such as urinating more often or urgently. Published by Elsevier Inc. The Pfizer, Moderna, and Novavax vaccines have been shown to be at least . Research into the relationship and potential treatments for COVID-19-related LUTS is still ongoing. Tip of the iceberg: erectile dysfunction and COVID-19, Implications of testicular ACE2 and the reninangiotensin system for SARS-CoV-2 on testis function, Long COVID and risk of erectile dysfunction in recovered patients from mild to moderate COVID-19, Is COVID-19 a risk factor for progression of benign prostatic hyperplasia and exacerbation of its related symptoms? Tentori, K., Passerini, A., Timberlake, B. Philos. & Azarpira, N. Covid-19 pathogenesis in prostatic cancer and TMPRSS2-ERG regulatory genetic pathway. ACE2 expression in different tissues is hypothesized to correlate with the risk of viral invasion, and results from several studies reported high expression levels of ACE2 in the genitourinary tract. COVID-19 variants have the potential to substantially increase mortality. The investigators hypothesized that what they called COVID-19-associated cystitis is caused by an increased inflammatory cytokine release into the urine and/or expression in the bladder72. COVID-19; adverse effects; lower urinary tract symptoms; vaccines. These results suggest that no substantial long-term threats on male fertility after recovery from COVID-19 exist, but the effect of COVID-19 on fertility might be worse for men with a long recovery time than for men who recover within a short time frame. Front. These contradictory findings might be explained by the anti-inflammatory properties of testosterone113,114, which could also explain why men with COVID-19 and high levels of testosterone (2.9ng/ml total testosterone at hospital admission) test positive for SARS-CoV-2 for a shorter time frame than those with total testosterone levels of <2.9ng/ml (median time to negative PCR test: 26 days versus 18days; P=0.002)115. Patients infected with the Delta variant showed further increased risk of hospitalization (OR 2.08 (95% CI 1.782.40), ICU admission (OR 3.35 (95% CI 2.604.31)) and death (OR 2.33 (95% CI 1.543.31))133. Everyone has them. Snchez-Gonzlez, J. V. et al. A phase 2 trial of the effect of antiandrogen therapy on COVID-19 outcome: no evidence of benefit, supported by epidemiology and in vitro data. Maringe, C. et al. To date, high-quality evidence of these pathophysiological processes in the urogenital system is limited. Soc. Hepatol. A wide range of severe pathological changes can be found in kidney tissue samples from patients with COVID-19 (refs41,42,44), but whether this damage is caused by an exuberant systemic inflammatory response31,41,48,49,50,52 or by a direct cytopathic effect of SARS-CoV-2 (refs31,53,54,55) is still unclear. Learn more here. CAS Due to the severe health risks associated with COVID-19 and the fact that re-infection with COVID-19 is possible, you should get the vaccine even if you've already had COVID-19. Infect. Am. Scientists theorize this could be a factor in post-COVID-19 LUTS, but more research is necessary to prove this. Nephrol. Results from the univariate analysis showed that total testosterone levels were inversely associated with increased risk of ICU admission (OR 0.54, P<0.0001) or death (OR 0.68, P<0.002)92. Physiol. Thus, whether the glomerular changes observed in this population (African American and Hispanic patients with COVID-19 who express the G1 and G2 risk alleles of APOL1) are a direct consequence of SARS-CoV-2 infection or emerge as a form of a second hit additional to a pre-existing risk factor is still unclear46. Controversial roles of the renin angiotensin system and its modulators during the COVID-19 pandemic. }); Salonia, A. et al. In both entry pathways, cleavage of the S2 site exposes the fusion peptide (FP) and induces dissociation of S1 from S2. BMJ Open 11, e048391 (2021). SARS-CoV-2 RNA shedding in semen and oligozoospermia of patient with severe coronavirus disease 11 weeks after infection. Maiese, A. et al. Venous thromboembolism in COVID-19: a systematic review and meta-analysis. Immunol. Rep. Urol. PubMed Infect. Practical Insights for Pharmacists: Drug and Vaccine Considerations for Acute Outpatient COVID-19. [Lower urinary tract symptoms and COVID-19] - PubMed Evidence of SARS-CoV-2 infection in gallbladder and - PubMed If a person is at risk of serious COVID-19 or has severe symptoms, they may need antiviral drugs. Do androgens modulate the pathophysiological pathways of inflammation? Immunol. Covid's latest unpleasant surprise: Sore gallbladder Would you like email updates of new search results? A. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. 63, 10061015 (2020). PMC SARS-CoV-2 is rarely detected in semen. Andrology 10, 3441 (2022). Fajgenbaum, D. C. & June, C. H. Cytokine storm. Given the common prevalence of many of these reported symptoms in the general population, there does not appear to be a correlation between vaccination and urologic symptoms, but as the vaccination criteria expands, further monitoring of the VAERS is needed.Copyright 2021. }); Urinary symptoms reported in patients with COVID-19 overlap with common diseases such as benign prostatic hyperplasia; therefore, proving SARS-CoV-2 is the underlying cause is difficult71. J. Pathol. Lancet 398, 223237 (2021). Thus, ACE2 might have a double role in COVID-19: pro-infection, acting as a cellular receptor for SARS-CoV-2, and protective during SARS-CoV-2 infection, by mitigating inflammation26,29. $("mega-back-specialties .mega-sub-menu").show(); High expression levels of the angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, can be found in the genitourinary tract, especially in kidney proximal tubule cells, bladder urothelial cells and testes. Results from an analysis of the FDA Vaccine Adverse Event Reporting System showed that <1% of vaccinated people described urological symptoms140. Of these . As the virus spread, new findings were published on a daily basis and, although the respiratory tract seemed to be the main field of interest, attention soon focused on extra-pulmonary manifestations of the infection5. HHS Vulnerability Disclosure, Help Hoffmann, M. et al. 39, 251.e255251.e257 (2021). CAS Before visiting a medical facility, people who are unsure if they have COVID-19 should follow local guidance for getting tested.
