key: cord-0831680-cg8r6t1g authors: Dhar, Nivedita; Dhar, Sorabh; Timar, Ryan; Lucas, Steven; Lamb, Laura E.; Chancellor, Michael B. title: De Novo Urinary Symptoms Associated With COVID-19: COVID-19-Associated Cystitis date: 2020-09-21 journal: J Clin Med Res DOI: 10.14740/jocmr4294 sha: fa56368caa1516f77a83990cd0ea4667df128ee3 doc_id: 831680 cord_uid: cg8r6t1g nan Clinical symptoms that present early in coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have been well-reported. Although the majority number of patients develop mild symptoms, a small percentage can progressively develop acute respiratory distress syndrome and multiple organ dysfunction syndrome resulting in demise [1] . There is an emergence of new symptoms that involve many organ systems, some more subtle than others. As these symptoms may overlap with other common disease processes, it has been difficult to identify and link these symptoms as direct association with COVID-19 as the underlying cause [2] . Recently Mumm and his colleagues have reported increased urinary frequency in COVID-19 patients [3] . We noticed at our tertiary care medical center's COVID-19 clinic that patients reported de novo urinary tract symptoms and therefore obtained institutional review board (IRB) approval for a case series. We surveyed urinary symptoms in patients who followed up in the outpatient setting after their hospitalization from COVID-19. All patients had confirmed positive SARS-CoV-2 molecular diagnostic test. Patients filled out their survey responses in the office setting. Urinary symptoms are based on a validated bladder health questionnaire (Overactive Bladder (OAB) Assessment Tool) [4] : The five individual symptom scores range from 0 to 5 based on urinary urgency, urge incontinence, incontinence, frequency, and nocturia. We noted patient's hospital dates to establish length-of-stay (LOS) and the study was conducted from May 22 to June 26, 2020. We identified 39 COVID-19-positive patients, including seven females and 32 males, who developed de novo urinary symptoms without urinary tract infection per standard urine culture and sensitivity testing. The patients were all outpatients post hospital discharge and did not have fever or other clinical conditions that would require inpatient health care. All patients were African American. Median LOS was 10 days (range 5 -30). All 39 patients completed the symptom score survey. The median total OAB symptom score in men and women was 18 (ranges 12 -20 and 15 -21, respectively) ( Table 1 ). Our case series bring awareness to the possibility of new onset urinary symptoms in COVID-19 patients and the cause of the symptoms remains unsolved. The most remarkable urologic complaints were increased urinary frequency of ≥ 13 episodes/24 h (85%) and nocturia ≥ four episodes/night (87%). In conclusion, in a limited survey of patients at a tertiary care COVID-19 clinic, we found COVID-19 patients, both men and women, may report de novo lower urinary tract symptoms. The most bothersome new urinary tract symptoms include urinary frequency and nocturia. Physicians caring for COVID-19 should be aware of COVID-19-associated cystitis (CAC). The cytokine storm and factors determining the sequence and severity of organ dysfunction in multiple organ dysfunction syndrome COVID-19: Importance of the Awareness of the Clinical Syndrome by Urologists Urinary Frequency as a Possibly Overlooked Symptom in COVID-19 Patients: Does SARS-CoV-2 Cause Viral Cystitis? None to declare. None to declare. The authors declare that they have no relevant conflict of interest to report. The data supporting the findings of this study are available from the corresponding author upon reasonable request.