A systematic review on COVID-19: urological manifestations, viral RNA detection and special considerations in urological conditions

Abstract

Purpose and objective We performed a systematic review on COVID-19 and its potential urological manifestations. Methods A literature search was performed using combination of keywords (MeSH terms and free text words) relating to COVID-19, urology, faeces and stool on multiple databases. Primary outcomes were the urological manifestations of COVID-19, and SARS-CoV-2 viral RNA detection in urine and stool samples. Meta-analyses were performed when there were two or more studies reporting on the same outcome. Special considerations in urological conditions that were relevant in the pandemic of COVID-19 were reported in a narrative manner. Results There were a total of 21 studies with 3714 COVID-19 patients, and urinary symptoms were absent in all of them. In patients with COVID-19, 7.58% (95% CI 3.30-13.54%) developed acute kidney injury with a mortality rate of 93.27% (95% CI 81.46-100%) amongst them. 5.74% (95% CI 2.88-9.44%) of COVID-19 patients had positive viral RNA in urine samples, but the duration of viral shedding in urine was unknown. 65.82% (95% CI 45.71-83.51%) of COVID-19 patients had positive viral RNA in stool samples, which were detected from 2 to 47 days from symptom onset. 31.6% of renal transplant recipients with COVID-19 required non-invasive ventilation, and the overall mortality rate was 15.4%. Conclusions Acute kidney injury leading to mortality is common amongst COVID-19 patients, likely as a result of direct viral toxicity. Viral RNA positivity was detected in both urine and stool samples, so precautions are needed when we perform transurethral or transrectal procedures.

Global change of surgical and oncological clinical practice in urology during early COVID-19 pandemic

“…Oncology: Treatment initiation rates during COVID-19 pandemic Fig. 3 Oncology: current treatment initiation rates of (neo)adjuvant/palliative treatment for 5 clinical conditions in metastatic/high-risk urologic cancer the risk for disease progression and association of delayed surgery with impaired surgical conditions and adverse survival outcomes [15][16][17][18].…”

Impact of COVID-19 on medical education: introducing homo digitalis

“…As healthcare systems in many countries have been overwhelmed by the COVID-19 pandemic, many physicians have found themselves either on the frontline, fighting COVID-19 alongside their critical care colleagues, or have suspended their clinical activities as a result of reprioritization of patient care [ 1 ]. Inevitably, COVID-19 has also affected the field of urology [ 2 – 5 ].…”

Sewage surveillance system using urological wastewater: Key to COVID-19 monitoring?

“…In many COVID-19 patients admitted into hospitals, urine analysis shows proteinuria (44%) and haematuria (27%) [35] . In critically ill patients, 15-58% patients have severe renal dysfunction, leading to death in 81-100% of patients [ 9 , 35 ]. As opposed to severe renal complications and abnormal urine analyses, the remainder of the urinary tract seems largely unaffected by COVID-19.…”

“…Since it is unclear whether the virus spreads via other bodily fluids than aerosols, the policy of using personal protective equipment in urological clinics is recommended. Over the past few months, contradictory evidence on the presence of (active) virus in bodily fluids was published [ 9 , 10 ]. In addition, it is largely unknown how viral load in bodily fluids is changing over time from the acute to recovery phase of the infection and to what extent patients are actually contagious through faeces, urine and semen.…”