Urinary Frequency as a Possibly Overlooked Symptom in COVID-19 Patients: Does SARS-CoV-2 Cause Viral Cystitis?

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic is a challenge for physicians in triaging patients in emergency rooms. We found a potentially dangerous overlap of classical urinary symptoms and the as yet not fully described symptoms of COVID-19. After a patient was primarily triaged as a urosepsis case and then subsequently diagnosed with COVID-19, we focused on an increase in urinary frequency as a symptom of COVID-19 and identified this in seven males out of 57 patients currently being treated in our COVID-19 wards. In the absence of any other causes, urinary frequency may be secondary to viral cystitis due to underlying COVID-19 disease. We propose consideration of urinary frequency as an anamnestic tool in patients with infective symptoms to increase awareness among urologists during the current COVID-19 pandemic to prevent fatal implications of misinterpreting urological symptoms.

Keywords: COVID-19; Triage; Urinary frequency; Urinary infection; Viral cystitis.

Fig. 1

Lung imaging for all the patients. Computed tomography lung imaging was performed for all patients on admission (±5 d). All patients showed signs of viral pneumonia, as evidenced from the images. (A,B) Images for patient 1 in the coronal and axial planes. (C–H) Images for patients 2–7, respectively, in the coronal plane. Predominantly bilateral ground glass opacification and typical COVID19-associated crazy paving areas are evident (C,F,H). COVID19 = coronavirus disease 2019.

Fig. 2

Potential mode of action. ACE2 has been described as the receptor for SARS-CoV-2, so urothelial cells might be affected in COVID-19 patients . As localization of expression is unclear so far, basal or luminal expression is possible, so two possible infection routes could be hypothesized: (1) infection via capillaries is possible, especially in the light of viraemia an infection route of interest; (2) infection via urine might be possible, as SARS-CoV-2 has been detected in urine elsewhere . (3) Alternatively, cystitis might be secondary due to local inflammation (eg, endotheliitis) . ACE2 = angiotensin-converting enzyme 2; COVID19 = coronavirus disease 2019; SARS-CoV-2; severe acute respiratory syndrome coronavirus 2.