MP29-15 Covid-19 Associated Cystitis (CAC): Increased Urinary Symptoms and Biomarkers of Inflammation in Urine in Patients with Acute Covid-19

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The Journal of Urology



Emerging evidence suggests that the bladder is one of many organs are targeted by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which contributes significantly to Coronavirus Disease 2019 (COVID-19) morbidity and leads to organ-specific complications. We were the first U.S. group to identify severe and bothersome de novo genitourinary symptoms in patients with confirmed SARS-CoV-2 infection, termed COVID-19 Associate Cystitis (CAC). We then sought to determine if this was associated with pro-inflammatory cytokines in the urine of patients.


With IRB approval, hospital discharged COVID-19 patients with normal renal function (N=53) and asymptomatic controls (N=12) completed an AUA Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to determine their current urinary symptoms (score of 0 to 25, increasing severity) and provided a urine sample. Urine samples were tested for SARS-CoV-2 using PCR, CRP by ELISA, and pro-inflammatory cytokines using Luminex assays following manufacturer’s instructions.


The median total OAB symptom score in both men and women with COVID-19 was 18 (range 4-21). The median total QOL score for both men and women with COVID-19 was 19 (range 8-24). Median age was 64.5 (range 47-82). Symptoms of CAC include increased urinary frequency, urgency, nocturia, and pain or pressure upon voiding. These symptoms were not due to urinary tract infection, acute renal injury, prostatitis, or urinary retention. These symptoms have caused worsening QOL in CAC patients, and nocturia the most bothersome symptom. The majority of COVID-19 patients did not have virus in their urine. The levels of GRO/CXCL-1, IL-6, IP-10, and CRP were significantly increased in urine samples from COVID-19 patients compared to controls.


COVID-19 patients reported severe de novo genitourinary symptoms, most notably an increase in urgency, frequency, and nocturia. SARS-CoV-2 infection results in increased expression of proinflammatory biomarkers in the urine. The variance between individuals may reflect the severity and duration of their disease, and/or the presence of comorbidities. This data supports that COVID-19 patients, especially those with CAC, have increased inflammatory cytokines in the urine.





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