Jackson, C. B., Farzan, M., Chen, B. COVID-19: angiotensin-converting enzyme 2 (ACE2) expression and tissue susceptibility to SARS-CoV-2 infection. Huang, C. et al. Getting a COVID-19 vaccine after you have recovered from COVID-19 infection provides added protection against COVID-19. Lamb, L. E. et al. These factors include: Having kidney or bladder stones. Careers. We have looked at the bladder and we have found declining white cells living in the bladder. Soc. Chest 159, 11821196 (2021). Santoriello, D. et al. Drake, T. M. et al. The detection of SARS-CoV-2 in urine is rare, although the virus can be detected in urine up to 52 days after disease onset. In a prospective, observational study, sperm quality after recovery from COVID-19 was assessed using the WHO criteria. Dis. Are sex disparities in COVID-19 a predictable outcome of failing mens health provision? However, mounting evidence suggests that infection with the Omicron variant of SARS-CoV-2 (lineage B.1.1.529) causes a milder disease phenotype than previous variants of concern134,135. Urinary tract infections can lead to intermittent secretion of IL-6 and IL-8 into the urine73; however, increased interleukin levels in urine are not specific for urinary tract infections at all and might only depend on renal excretion of plasma interleukins. The most common finding in native biopsy samples (25.8% of patients) was collapsing glomerulopathy, also known as COVID-19-associated nephropathy (COVAN)44. Last medically reviewed on January 31, 2023. }); Giuseppe Magistro. -, Valera-Rubio M., Sierra-Torres M.I., Garca R.C., Cordero-Ramos J., Lpez-Mrquez M.R., Cruz-Salgado O., Calleja-Hernndez M.A. 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. Iba, T., Connors, J. M. & Levy, J. H. The coagulopathy, endotheliopathy, and vasculitis of COVID-19. According to the authors of the recent paper, studies have shown that 10-25% of people with a UTI have contracted an infection. Fajgenbaum, D. C. & June, C. H. Cytokine storm. 2014 Oct 27;14:84. doi: 10.1186/1471-2490-14-84. However, no data on histopathological changes in patients with non-fatal COVID-19 are available; therefore, whether the alterations in testes are a general consequence of COVID-19 or exclusively occur in patients with fatal COVID-19 is still unclear. }); BJU Int. 2014 May;113(5):696-703. doi: 10.1111/bju.12555. Patients treated with enzalutamide required longer hospitalization (hazard ratio for discharge from hospital: 0.43, 95% CI 0.200.93) than patients treated with the standard of care117. The G1 and G2 alleles of the apolipoprotein L1 (APOL1), which are very frequent in men with African ancestry and greatly increase the risk of multiple types of kidney disease45, were found in 91.7% of the tested kidney biopsy samples from African American and Hispanic patients with COVAN44. De novo lower urinary tract symptoms (LUTS) were observed in 43 patients and deterioration of pre-existing LUTS in 7. Evidence for ACE2-independent cell damage in kidney cells has also been reported. Infect. Department of Urology, University of Texas Southwestern, Dallas TX. Another 2022 study found that those who had COVID-19 with symptoms had three times the risk of developing urinary symptoms than people who did not have COVID-19. 92, 551571 (2017). The Pfizer, Moderna, and Novavax vaccines have been shown to be at least . Health 39, 6574 (2021). PubMed An official website of the United States government. Am. Modeling the contribution of male testosterone levels to the duration of positive COVID testing among hospitalized male COVID-19 patients. Ye, Q., Wang, B. Patients with highly prevalent risk factors, such as diabetes, obesity or hypertension, are at an increased risk of developing SARS-CoV-2-mediated AKI (adjusted odds ratio (OR): 1.76 for diabetes, 1.11 for obesity and 1.25 for hypertension)36,37. Acute kidney injury in COVID-19: are kidneys the target or just collateral damage? & Pollak, M. R. APOL1 and kidney disease: from genetics to biology. Coto, E., Avanzas, P. & Gmez, J. 59, 41804184 (1999). Lancet 395, 497506 (2020). USA 118, e2021450118 (2021). In another study, results from ten autopsies performed on deceased men with COVID-19 (median age: 49.5 years) revealed morphological testes alterations in 70% of patients, attributable to oxidative stress, as well as sloughing of spermatocytes, elongation of spermatids, swelling of Sertoli cells and multifocal microthrombi81. 2021;106:376381. An overactive bladder, cystitis, and other bladder dysfunctions led by bladder inflammation have been reported to occur following COVID-19. Male hypogonadism. Mortality among US patients hospitalized with SARS-CoV-2 infection in 2020. They function as part of the immune system but may pass into the urine. Cytokine-storm-induced systemic inflammatory response and direct cytopathic effects are possible pathophysiological mechanisms of AKI. The authors declare no conflict of interest. Luppi, F., Arpino, B. Nat. Thus, a substantial effect of COVID-19 on the hormonal balance is observed during the acute phase of the infection, but whether this imbalance has long-term repercussions for the total testosterone balance is still unclear90,97. 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. 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. Biol. Kidney disease is associated with in-hospital death of patients with COVID-19. Proc. Microbiol. In a study analysing sperm parameters before and after COVID-19 mRNA vaccination in 45 men (median age: 28 years) receiving BNT162b2 (Pfizer-BioNTech, 46.7%) or mRNA-1273 (Moderna, 53.3%), no substantial decrease in any sperm parameter was reported141. These results indicate that, although the testes might be heavily affected by a SARS-CoV-2 infection under other circumstances79,81, in these patients, the cause of the imbalances in total testosterone levels lies in the central nervous system, as secondary hypogonadism indicates a problem in the pituitary gland or hypothalamus94. Prog. COVID-19 inflammation results in urine cytokine elevation and causes COVID-19 associated cystitis (CAC). Lucas, J. M. et al. Article Health https://doi.org/10.1136/bmjgh-2021-005427 (2021). Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19. }); Accessibility Case: A 14-year-old patient reported vulvar pain and visible lesion. BRCA Testing and Adjuvant Therapy in Early Breast Cancer: Experiences and Challenges. MNT is the registered trade mark of Healthline Media. Innov. Urine, expressed prostatic secretion and semen were analysed for SARS-CoV-2 detection, and the PCR was negative in all the samples collected in all patients. The authors attributed the protective effect of ADT to its ability to decrease TMPRSS2 levels108, which has an important role in the fusion process of cellular and viral membranes20, and to a reduction of the risk of a cytokine storm by decreasing the number and function of circulating neutrophils107,109. Rev. Pulmonary pathology and COVID-19: lessons from autopsy. Controversial roles of the renin angiotensin system and its modulators during the COVID-19 pandemic. Incidence of VTE and bleeding among hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis. Urinary viral shedding of COVID-19 and its clinical associations: a systematic review and meta-analysis of observational studies. 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. Elhence, A. et al. Article Adverse events reported after administration of BNT162b2 and mRNA-1273 COVID-19 vaccines among hospital workers: A cross-sectional survey-based study in a Spanish hospital. Another reason for vaccine refusal is a misunderstanding about vaccine efficacy. Vaccines. 69, 11811189 (2020). 10, 779782 (2020). Dhar, N. et al. 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. Hepatol. However, they know that the kidneys and bladder are responsible for removing waste from the body, and this can include alive or dead viruses. Fallara, G. et al. Thus, the discussion on the effects of RAAS blockers on the outcome of patients with COVID-19 has been quite controversial26; however, drugs targeting the RAAS have shown no relevant improvements in the risk of COVID-19 infection and disease outcome30. The trial was terminated early and the authors concluded that androgen inhibition should not be used for prevention or treatment of COVID-19 (ref.117). PLoS ONE 16, e0257641 (2021). J. Infect. Vasc. However, SARS-CoV-2 was detected in urine up to 52days after disease onset, indicating that the virus might be detectable in urine in the acute stage of COVID-19 and also after recovery58. In urology, evidence suggests that kidneys and testes are at a particularly high risk of severe damage following COVID-19 infection17,18. Med. The role of intravesical prostatic protrusion in the evaluation of overactive bladder in male patients with LUTS. Wong, L. E. et al. In another study, sperm quality was assessed in 74men aged between 20 and 50 years, who were recovering from COVID-19 (two consecutive negative pharyngeal swab PCR tests were required for inclusion)90. Urol. A higher mortality rate for COVID-19 in men than in women has been reported in multiple studies99,100. Mukherjee, A., Ghosh, R. & Furment, M. M. Case report: COVID-19 associated renal infarction and ascending aortic thrombosis. }); To quantify and describe urologic adverse events and symptoms after vaccination with the Pfizer-BioNTech and Moderna COVID-19 vaccines.We queried the FDA Vaccine Adverse Event Reporting System (VAERS) for all reported symptoms following the Pfizer-BioNTech and Moderna vaccines as of February 12th, 2021. Our study describes the potential for a highly effective bladder vaccine that can not only eradicate residual bladder bacteria but also prevent future infections," says senior author Soman Abraham, Ph.D., a professor of Pathology, Immunology and Molecular Genetics & Microbiology with Duke University's School of Medicine. A doctor can determine if this is the case with a urine test. A case of SARS-CoV-2 Side effects of BNT162b2 mRNA COVID-19 vaccine: A randomized, cross-sectional study with detailed self-reported symptoms from healthcare workers. It causes waste to build up in your blood and can be deadly. World Health Organization reference values for human semen characteristics. Nephrol. Sperm motility and vitality significantly decreased (P0.03) in these patients after COVID-19 infection compared with the values from a spermiogram analysis performed in the same patients within the year before SARS-CoV-2 onset. 202, 162192 (2020). 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. They may also perform a physical examination to look for signs of pain or infection. These results suggest that COVID-19 can affect testis and epididymis in the acute stage of the infection, although these effects might be clinically inapparent in many instances. Getting a COVID-19 vaccine gives most people a high level of protection against COVID-19 and can provide added protection for people who already had COVID-19. Analysis of the effects of COVID-19 infection on male reproductive health through histopathological examinations showed that testicular tissue can be severely damaged by SARS-CoV-2 infection79,81 (Fig. Division of Urology, Cedars-Sinai Medical Center, Los Angeles CA. 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. Hepatol. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19. Salonia, A. et al. Soc. 289, 114273 (2021). Viral cystitides dependent on SARS-CoV-2 infection have been observed since the beginning of the pandemic, with a high urinary frequency observed in 7 of 57 men with COVID-19, who had no signs of AKI, bacterial infection or prostatitis67. made a substantial contribution to discussion of the content. Finelli, L. et al. The androgen-regulated protease TMPRSS2 activates a proteolytic cascade involving components of the tumor microenvironment and promotes prostate cancer metastasis. "Initially, it was thought that the disease affects the lungs only. Keywords: Duarte, S. A. C., Pereira, J. G., Iscaife, A., Leite, K. R. M. & Antunes, A. Klein, E. A. et al. 9, 247255 (2021). A 2022 study calls this condition COVID-19-associated cystitis (CAC) due to a theory that inflammation is the cause. Troiano, G. & Nardi, A. This is a webinar about Bladder Cancer and COVID-19 Treatment and Vaccine Update for Patients and Families. The absence of statistically significant differences in IPSS before and during COVID-19 in patients <50 years might be explained by the small sample size of this age group in this study (n=32)70. Chan, L. et al. Gonzalez, D. C. et al. However, the impact on the virus infecting the biliary system, especially the gallbladder, has remained unclear and no pathological evidence has been reported yet. Int. After the acute phase of SARS-CoV-2 infection, patients might still suffer from fatigue, breathing difficulty and fever14. Severe structural changes can be detected in kidney biopsy samples from patients with COVID-19 (refs41,42). Of these . Rev. Intern. volume19,pages 344356 (2022)Cite this article. Immunol. Swollen sinuses could be a result of COVID-19. Novel Coronavirus(2019-nCoV) Situation Report 22. WHO https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf?sfvrsn=fb6d49b1_2 (2020). J. Bras. On 11 March 2020, the WHO declared the COVID-19 outbreak a pandemic4. Infect. Sigal, A. Milder disease with Omicron: is it the virus or the pre-existing immunity? Urology soon emerged as a focus of interest, owing to a potential threat of long-term damage induced by COVID-19 to kidney function, fertility and hormonal balance. Microbiol. & Choe, H. Mechanisms of SARS-CoV-2 entry into cells. Single-cell transcriptome analysis of the novel coronavirus (SARS-CoV-2) associated gene ACE2 expression in normal and non-obstructive azoospermia (NOA) human male testes. Nat. Current findings on urological symptoms of COVID-19 and damage to organs of the genitourinary tract induced by SARS-CoV-2 infection are also presented. Transduct. Calabrese, F. et al. At this time, it is unknown how long immunity may last. 16, e07 (2021). The COVID-19 pandemic what have urologists learned?. 12, 624052 (2021). Qiao, Y. et al. Cystitis refers to inflammation of the bladder. jQuery(function($) { Opin. Dis. & Wang, J. ACE2 expression in kidney and testis may cause kidney and testis infection in COVID-19 patients. However, contradictory evidence makes it difficult to understand whether or not hormonal imbalance in patients recovering from COVID-19 is only a temporary phenomenon of the acute stage of infection90,97. https://doi.org/10.1093/jtm/taaa008 (2020). 117, 287296 (2022). 5) and urologists must learn to detect and manage short-term and long-term damage to the genitourinary tract caused by COVID-19 for the benefit of patients. 26, 415425 (2021). Pediatr. A total of 156 urologic symptoms were described amongst the 113 adverse event reports. Rev. If COVID-19 affects a persons urinary tract, they may need to urinate: In some cases, people have also reported passing blood or pus in their urine. Thus, this method has been also discussed as a possible tool to evaluate hospital discharge of patients with COVID-19 (ref.59). A. Viruses in the mammalian male genital tract and their effects on the reproductive system. Ediz, C. 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. 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. Androgen signaling regulates SARS-CoV-2 receptor levels and is associated with severe COVID-19 symptoms in men. 160, 25372540 (2000). We investigated the storage lower urinary tract symptoms (LUTS) before and after the first dose of coronavirus disease 2019 (COVID-19) vaccine and the association between pre-vaccinated overactive bladder (OAB) and the worsening of storage LUTS following COVID-19 vaccination. Friedman, D. J. 103, 19891992 (2020). When will the COVID-19 Pandemic End? Leukocytes are white blood cells. Eur. 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. 34, 267268 (2021). On this basis, cell types with >1% of ACE2+ cells were considered at a high risk of SARS-CoV-2 infection. $('mega-back-mediaresources').on('click', function(e) {

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