COVID-19 tied to elevated risk of benign prostatic hyperplasia complications

A recent study published in the Journal of Internal Medicine investigates the correlations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and benign prostatic hyperplasia (BPH).

Study: SARS‐CoV‐2 infection correlates with male benign prostatic hyperplasia deterioration. Image Credit: Fotoluminate LLC / Shutterstock.com

Can SARS-CoV-2 infect the prostate?

SARS-CoV-2, the causal agent of the coronavirus disease 2019 (COVID-19), can infect extrapulmonary systems. Prostate epithelial cells express both angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), thus suggesting that SARS-CoV-2 can infect the lower urinary tract in males.

Metabolic syndrome and diabetes mellitus are known risk factors for lower urinary tract symptoms (LUTS) that can impact the prostate. SARS-CoV-2 is known to cause new-onset metabolic complications, which could aggravate LUTS.

BPH can cause urinary tract infections (UTIs), retention of urine (ROU), bladder stones, and hematuria. Like COVID-19, BPH is prevalent among aging males, with an estimated incidence of 80% in adults 70 years of age and older; therefore, COVID-19 patients may be more likely to develop BPH complications. Currently, there is limited evidence on the relationship between COVID-19 and LUTS.

About the study

In the present study, researchers explore the correlations between COVID-19 and BPH. Relevant data were retrieved from a patient record database of the Hong Kong Hospital Authority.

Patients on monotherapy with long-acting alpha-1 adrenoreceptor blockers (AARBs) for LUTS in 2021 and 2022 were included. Individuals with a history of urolithiasis or prostate cancer in the past five years or ROU in the past year were excluded.

Subjects with a positive SARS-CoV-2 polymerase chain reaction (PCR) test were included in the COVID-19 group, while those without a positive PCR test were in the control group. The study outcomes included the incidence of BPH complications such as UTI, bacteriuria, hematuria, and ROU, as well as the addition of a 5-alpha reductase inhibitor (5ARI) as a combination therapy for LUTS.

Data on UTI, hematuria, and ROU were based on clinical diagnosis codes in the database, whereas bacteriuria was determined based on positive urine cultures. Propensity scores were calculated using logistic regression, and propensity score matching was performed to adjust/balance potential confounders.

A chi-squared test compared the outcomes between SARS-CoV-2-infected and control groups. Sub-group analyses were performed by age groups and COVID-19 severity.

COVID-19 severity was defined based on medications such as interferons, antivirals, or steroids, hospitalization, intensive care requirement, and intervention, including oxygen therapy or extracorporeal membrane oxygenation.

Study findings

A total of 192,435 males received AARB monotherapy. After exclusions, there were 176,006 subjects, including 10,651 individuals who tested positive for SARS-CoV-2 infection.

After propensity score matching, 17,986 individuals were retained for analyses, with each group comprising 8,993 subjects. There were significant differences in outcomes between COVID-19 and control groups, with the COVID-19 group associated with a higher incidence of ROU, hematuria, bacteriuria, and 5ARI use.

The incidence of BPH complications was significantly higher across most age groups, except those of a younger age. There were significant differences in the incidence of bacteriuria and ROU in individuals 50 years of age and older, as well as UTI incidence and 5ARI use in patients 60 and older. The incidence of ROU, hematuria, and 5ARI use did not differ by COVID-19 severity.

The incidence of bacteriuria and UTI was significantly lower in patients with asymptomatic or mild COVID-19. Furthermore, in sub-group analyses by COVID-19 supportive medical therapy, hematuria incidence was consistently higher after excluding patients on heparin therapy. Likewise, the incidence of bacteriuria and UTI remained higher after excluding patients prescribed steroids.

Conclusions

SARS-CoV-2 infection was associated with an increased incidence of BPH complications and 5ARI use in males treated for baseline LUTS. The strong positive correlation suggests significant urological manifestations of COVID-19; therefore, it is crucial for urologists and clinicians to be aware of this additional burden.

Sub-group analyses revealed a significantly higher incidence of BPH complications among patients of an older age. Notably, there were no differences in the incidence of hematuria or urinary retention and 5ARI use by COVID-19 severity, thus indicating that these urological manifestations may occur even in patients with mild or asymptomatic COVID-19.