Research in the Journal of Internal Medicine indicates that SARS-CoV-2 infections may worsen lower urinary tract symptoms (LUTS) in men, based on 18,000 men treated for LUTS in Hong Kong in 2021 and 2022.
This study, the authors say, is the largest to show COVID-19 can result in increased rates of benign prostate hyperplasia (BPH), or enlargement of the prostate, resulting in a number of urinary symptoms. The study suggests the male reproductive tract is a site for COVID-19-related inflammation and pathophysiology.
The study included outcomes among 17,986 men seeking treatment for LUTS. All patient records were gathered from Hong Kong Hospital Authority, the sole healthcare provider in Hong Kong. All patients were on monotherapy for LUTS, in the form of long-acting alpha-1 adrenoreceptor blockers, and seen between January 1, 2021, and December 31, 2022.
Case patients had a positive PCR test for COVID-19 while seeking treatment for LUTS, and controls were negative. A total of 10,651 patients had a positive PCR test for SARS-CoV-2.
COVID-19 patients had much higher rates of urine retention
The authors found striking differences between urinary symptoms in cases and controls. The group with SARS-CoV-2 had significantly higher rates of retention of urine (4.55% versus 0.86%), bacteria in the urine (9.02% versus 1.97%), and blood in the urine (1.36% versus 0.41%).
The statistically significant higher incidence of BPH complications and outcomes in SARS-CoV-2 patients can be consistently observed across the majority of the age groups.
"Subgroup analysis stratified by age showed that the statistically significant higher incidence of BPH complications and outcomes in SARS-CoV-2 patients can be consistently observed across the majority of the age groups, with the exception of younger age groups," the authors said.
Urinary symptoms were not associated with COVID-19 severity, except in the case of urinary tract infections. Patients with asymptomatic COVID-19 were less likely to suffer infections.
"The lower incidence of UTI and bacteriuria observed in patients with low severity COVID-19 is postulated to be related to a relatively higher risk of UTI in patients with more severe disease due to immunocompromised state as well as possible catheterization,” the authors said.
"We are excited to be the first to report the effects of COVID-19 on complications of benign prostatic hyperplasia—or enlarged prostate—and also demonstrate the alarming extent of its urological effects," said corresponding author Alex Qinyang Liu, MD, of Hong Kong's Prince of Wales Hospital, in a press release on the study.