Kulchavenya E V, Shevchenko S Yu
GBOU VPO Novosibirsk State Medical University of Ministry of Health of Russia, Novosibirsk, Russia.
Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation, Nizhny Novgorod, Russia.
Urologiia. 2023 Mar(1):41-45.
There are publications about the impact of a new coronavirus infection (COVID) on the lower urinary tract, including the development of overactive bladder (OAB) or COVID-associated cystitis. The cause of dysuria in patients with COVID is not fully understood.
A total of 14 consecutive patients after COVID with complaints of frequent urination with urgency were included in the study. The main inclusion criterion was the development or worsening of OAB symptoms after resolution of COVID, confirmed by the eradication of SARS-CoV-2 by a polymerase chain reaction. The severity of OAB was assessed using the International Scale of Symptoms (Overactive Bladder Symptom Score, OABSS).
Three (21.4%) out of fourteen patients had OAB symptoms prior to COVID, while in 11 (78.6%) patients OAB symptoms developed in post-COVID period. In 4 patients (28.6% of the entire cohort and 36.4% of patients in de novo group) urge urinary incontinence and urgency developed. The average score on the OABSS scale in patients with baseline OAB was 6.7+/-0.8, which corresponded to the moderate severity. In this group, one patient developed urge urinary incontinence and urgency, which were not present prior to COVID. In a retrospective evaluation of symptoms before the COVID, their average score on the OABSS scale was 5.2 +/- 0.7, i.e., past COVID led to an increase in OAB symptoms by 1.5 points. In patients with OAB de novo, the symptoms were less pronounced, with a score of 5.1+/-0.6 points, that is between mild and moderate OAB. At the same time, urinalysis in 9 patients did not have signs of inflammation: in 5 cases, 5-7 white blood cells per field of view was seen only once. A follow-up urine test was normal, suggesting contamination. None of the cases revealed bacteriuria over 102 CFU/ml. All patients were prescribed trospium chloride at a dose of 30 mg per day. The choice of the drug was due to the absence of a negative effect on the central nervous system, which is very important both during COVID and in post-COVID period, since the neurotoxicity of SARS-CoV-2 has been proven.
A past history of COVID led to an increase in OAB symptoms by 1.5 points in patients who had OAB prior to infection. In 11 patients, after the treatment of COVID, the moderate symptoms of OAB developed de novo. Our small study showed the importance of focusing the attention of internists and infectious disease doctors on urination disorders in patients with COVID and timely referral to a urologist. For the treatment of post-COVID OAB, trospium chloride is the drug of choice, as it does not aggravate the potential neurotoxicity of SARS-CoV-2.
有关于新型冠状病毒感染（COVID）对下尿路影响的文献报道，包括膀胱过度活动症（OAB）的发生或COVID相关膀胱炎。COVID患者尿痛的原因尚未完全明确。
本研究共纳入14例COVID康复后出现尿频伴尿急症状的连续患者。主要纳入标准是COVID症状缓解后OAB症状出现或加重，通过聚合酶链反应检测到SARS-CoV-2被清除来确认。使用国际症状量表（膀胱过度活动症症状评分，OABSS）评估OAB的严重程度。
14例患者中，3例（21.4%）在感染COVID之前就有OAB症状，而11例（78.6%）患者在COVID康复后出现OAB症状。4例患者（占整个队列的28.6%，新发组患者的36.4%）出现急迫性尿失禁和尿急。基线时患有OAB的患者OABSS量表的平均评分为6.7±0.8，对应中度严重程度。在该组中，1例患者出现了COVID之前不存在的急迫性尿失禁和尿急。在对COVID之前症状的回顾性评估中，他们在OABSS量表上的平均评分为5.2±0.7，即既往感染COVID导致OAB症状增加了1.5分。在新发OAB的患者中，症状较轻，评分为5.1±0.6分，处于轻度和中度OAB之间。同时，9例患者的尿液分析没有炎症迹象：5例患者仅在一次视野中看到每视野5 - 7个白细胞。后续尿液检查正常，提示污染。所有病例均未发现细菌尿超过10²CFU/ml。所有患者均被开具了每日30毫克的曲司氯铵。选择该药物是因为其对中枢神经系统没有负面影响，这在COVID期间和COVID康复后都非常重要，因为SARS-CoV-2的神经毒性已得到证实。
既往感染COVID史使感染前就患有OAB的患者OAB症状增加了1.5分。11例患者在COVID治疗后新发中度OAB症状。我们的小型研究表明，内科医生和传染病医生应关注COVID患者的排尿障碍并及时转诊给泌尿科医生。对于治疗COVID康复后的OAB，曲司氯铵是首选药物，因为它不会加重SARS-CoV-2潜在的神经毒性。
