Amir H Kashi1, Jean De la Rosette2, Erfan Amini3, Hamidreza Abdi4, Morteza Fallah-Karkan5, Maryam Vaezjalali6. 1. Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ahkashi@gmail.com. 2. Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey. 3. Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 4. Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Canada. 5. Department of Urology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran. 6. Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. . maryam.vaezjalali@gmail.com.
Abstract
OBJECTIVES: To review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine. MATERIALS AND METHODS: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of ≥ 9. RESULTS: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of ≥ 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the meta-analysis. Urinary viral load in most reports were lower than rectal or oropharyngeal samples. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding. CONCLUSION: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization especially in symptomatic adult patients while in children caution should be exerted regardless of symptoms.
OBJECTIVES: To review the current literature on the presence of COVID-19 virus in the urine of infectedpatients and to explore the clinical features that can predict the presence of COVID-19 in urine. MATERIALS AND METHODS: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infectedpatients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of ≥ 9. RESULTS: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of ≥ 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the meta-analysis. Urinary viral load in most reports were lower than rectal or oropharyngeal samples. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding. CONCLUSION: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19infectedpatients during medical interventions like endoscopy and urethral catheterization especially in symptomatic adult patients while in children caution should be exerted regardless of symptoms.
Authors: Fabio Crocerossa; William Visser; Umberto Carbonara; Ugo Giovanni Falagario; Savio Domenico Pandolfo; Davide Loizzo; Ciro Imbimbo; Adam P Klausner; Francesco Porpiglia; Rocco Damiano; Francesco Cantiello; Riccardo Autorino Journal: Cent European J Urol Date: 2022-01-13
Authors: Laura E Lamb; Ryan Timar; Melissa Wills; Sorabh Dhar; Steve M Lucas; Dragana Komnenov; Michael B Chancellor; Nivedita Dhar Journal: Int Urol Nephrol Date: 2021-11-17 Impact factor: 2.266