COVID-19 associated with increased BPH complications and deterioration

SARS-CoV-2 infection is associated with significantly higher incidence of benign prostatic hyperplasia (BPH) complications and addition of 5-alpha reductase inhibitor (5ARI) for combination therapy in male patients with lower urinary tract symptoms (LUTS) on alpha-1 adrenoreceptor blocker (AARB) monotherapy, a territory-wide retrospective cohort study in Hong Kong has shown.

The study, conducted by researchers from the Division of Urology, Department of Surgery, Chinese University of Hong Kong, included 17,986 propensity score–matched patients on AARB monotherapy for LUTS between January and December 2021, whose data were retrieved from the Hospital Authority’s electronic patient record database. Of these patients, 8,993 tested positive for SARS-CoV-2 on polymerase chain reaction (PCR) assay (mean age, 75.59 years; diabetes, 35.76 percent; hypertension, 62.93 percent), while 8,993 patients with no positive PCR test result for SARS-CoV-2 served as the control group (mean age, 76.68 years; diabetes, 36.86 percent; hypertension, 63.99 percent). [J Intern Med 2023;294:775-783]

Compared with controls, those with SARS-CoV-2 infection had a relative risk of 5.31 for retention of urine (incidence rate [IR], 4.55 percent vs 0.86 percent; p<0.001), 4.58 for bacteriuria (IR, 9.02 percent vs 1.97 percent; p<0.001), 3.3 for haematuria (IR, 1.36 percent vs 0.41 percent; p<0.01), and 2.9 for urinary tract infection (IR, 4.31 percent vs 1.49 percent; p<0.001). The RR for addition of 5ARI for combination treatment of LUTS was 25 (IR, 0.5 percent vs 0.02 percent; p<0.001) in patients with vs without SARS-CoV-2 infection.

“Notably, we found no significant difference in the incidence of urinary retention [p=0.066] or haematuria [p=0.142] across subgroups of patients stratified by COVID-19 severity, suggesting that even patients with asymptomatic or mild COVID-19 can still be affected urologically and suffer from BPH complications,” said Dr Alex Liu, first author of the study.

Addition of 5ARI for combination therapy also did not differ significantly across subgroups stratified by COVID-19 severity (p=0.833).

“Older BPH patients were, however, more susceptible to urological complications than younger patients after SARS-CoV-2 infection,” said Dr Jeremy Teoh.

Across the majority of subgroups >50 years of age, a significantly higher incidence of BPH complications and addition of 5ARI for combination therapy was consistently observed in patients with SARS-CoV-2 infection vs controls. The incidence of these outcomes of interest was higher in older age groups.

Additional subgroup analyses were performed based on heparin and steroid use, due to the potential confounding effects of supportive medical therapy for COVID-19. After excluding patients on heparin, a higher incidence of haematuria was still consistently observed in patients with SARS-CoV-2 infection vs controls (1.44 percent vs 0.35 percent; p<0.001). After excluding patients on steroids, higher incidence of urinary tract infection (3.62 percent vs 1.29 percent; p<0.001) and bacteriuria (6.52 percent vs 1.74 percent; p<0.001) was still observed in infected patients.

“This is the largest study demonstrating the detrimental urological effects of SARS-CoV-2 infection in male patients on medical treatment for LUTS,” the researchers noted.

“The higher risks of urological complications in BPH patients with COVID-19 represent a significant clinical burden that clinicians and urologists should be aware of,” commented Teoh.