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Abstract：
BACKGROUND: During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the management of patients with lower urinary tract symptoms (LUTS) underwent dynamic adjustments in response to an evolving understanding of the virus\'s impact on different patient populations. Healthcare practitioners reevaluated therapeutic approaches for conditions like benign prostatic hyperplasia (BPH), considering the potential implications of this condition on the severity and progression of coronavirus disease 2019 (COVID-19). This study aims to investigate potential correlations between SARS-CoV-2 infection severity, exacerbation of LUTS, and BPH progression.
METHODS: This retrospective study includes patients hospitalized in our Urology Department between January 2021 and January 2023, presenting with both SARS-CoV-2 and BPH. Their ages ranged from 57 to 88 years, with a mean age of 65.4 years. The diagnosis of BPH relied on a diagnostic triad consisting of digital rectal examination, biological markers (including prostate-specific antigen (PSA) and free PSA, and ultrasound examination, with both conditions confirmed based on test results. Transurethral resection of the prostate (TURP) procedures utilized monopolar Karl Storz resection equipment, using sorbitol and bipolar Olympus devices for transurethral resection of the prostate in saline (TURPis). Haemostasia was performed using roller balls. Anticoagulation followed a prescribed scheme by cardiologists and infectious disease specialists. Statistical analysis was conducted using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
RESULTS: Among the 138 hospitalized patients affected by both BPH and COVID-19, 18 required emergency endoscopic procedures (specifically TURP or TURPis) to achieve hemostasis (Figures 1, 2). These individuals presented persistent hematuria despite conservative treatments. The mean duration of surgery was 57.9 minutes. Patients who underwent surgery had a longer average hospital stay compared to those who did not, with durations of 10.5 days versus 7.5 days, respectively. Additionally, urethrovesical catheter insertion was necessary in 29 cases due to acute urinary retention or worsening voiding symptoms during hospitalization. These patients are scheduled for further urological evaluation following the resolution of the COVID-19 episode. In a cohort of 53 patients for whom data were accessible, comparisons were made between the pre-COVID status and the levels of the International Prostate Symptom Score (IPSS), post-voiding residue (PVR), and quality of life (QoL). The findings revealed a mean pre-COVID IPSS value of 11.6 and a COVID-related value of 14.2, with a statistically significant difference noted (p < 0.05). The mean pre-COVID PVR was 42.3 cm2, whereas during the COVID-19 period, it measured 62.5 cm2, also exhibiting a significant difference (p < 0.05). Additionally, the QoL showed a mean pre-COVID-19 score of 2.4 and a COVID-19-associated score of 2.9, again demonstrating statistical significance (p < 0.05).
CONCLUSIONS: The onset of the SARS-CoV-2 pandemic posed novel challenges in the medical realm, impacting the approach to BPH management. A common practice was delaying treatment for chronic BPH until viral infection remission to reduce associated risks. Additionally, our study revealed a worse evolution in LUTS among individuals with severe COVID-19 symptoms.
METHODS: This retrospective study includes patients hospitalized in our Urology Department between January 2021 and January 2023, presenting with both SARS-CoV-2 and BPH. Their ages ranged from 57 to 88 years, with a mean age of 65.4 years. The diagnosis of BPH relied on a diagnostic triad consisting of digital rectal examination, biological markers (including prostate-specific antigen (PSA) and free PSA, and ultrasound examination, with both conditions confirmed based on test results. Transurethral resection of the prostate (TURP) procedures utilized monopolar Karl Storz resection equipment, using sorbitol and bipolar Olympus devices for transurethral resection of the prostate in saline (TURPis). Haemostasia was performed using roller balls. Anticoagulation followed a prescribed scheme by cardiologists and infectious disease specialists. Statistical analysis was conducted using IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
RESULTS: Among the 138 hospitalized patients affected by both BPH and COVID-19, 18 required emergency endoscopic procedures (specifically TURP or TURPis) to achieve hemostasis (Figures 1, 2). These individuals presented persistent hematuria despite conservative treatments. The mean duration of surgery was 57.9 minutes. Patients who underwent surgery had a longer average hospital stay compared to those who did not, with durations of 10.5 days versus 7.5 days, respectively. Additionally, urethrovesical catheter insertion was necessary in 29 cases due to acute urinary retention or worsening voiding symptoms during hospitalization. These patients are scheduled for further urological evaluation following the resolution of the COVID-19 episode. In a cohort of 53 patients for whom data were accessible, comparisons were made between the pre-COVID status and the levels of the International Prostate Symptom Score (IPSS), post-voiding residue (PVR), and quality of life (QoL). The findings revealed a mean pre-COVID IPSS value of 11.6 and a COVID-related value of 14.2, with a statistically significant difference noted (p < 0.05). The mean pre-COVID PVR was 42.3 cm2, whereas during the COVID-19 period, it measured 62.5 cm2, also exhibiting a significant difference (p < 0.05). Additionally, the QoL showed a mean pre-COVID-19 score of 2.4 and a COVID-19-associated score of 2.9, again demonstrating statistical significance (p < 0.05).
CONCLUSIONS: The onset of the SARS-CoV-2 pandemic posed novel challenges in the medical realm, impacting the approach to BPH management. A common practice was delaying treatment for chronic BPH until viral infection remission to reduce associated risks. Additionally, our study revealed a worse evolution in LUTS among individuals with severe COVID-19 symptoms.
摘要：
背景：在严重急性呼吸系统综合症冠状病毒2（SARS-CoV-2）大流行期间，对下尿路症状(LUTS)患者的管理进行了动态调整,以应对病毒对不同患者人群的影响的不断发展的认识.医疗保健从业人员重新评估了良性前列腺增生（BPH）等疾病的治疗方法，考虑这种情况对2019年冠状病毒病（COVID-19）的严重程度和进展的潜在影响。这项研究旨在调查SARS-CoV-2感染严重程度之间的潜在相关性。LUTS恶化，和BPH进展。
方法：这项回顾性研究包括2021年1月至2023年1月在泌尿外科住院的SARS-CoV-2和BPH患者。他们的年龄从57岁到88岁，平均年龄65.4岁。BPH的诊断依赖于由直肠指检组成的诊断三联征,生物标志物（包括前列腺特异性抗原（PSA）和游离PSA，和超声检查，根据测试结果确认了这两个条件。经尿道前列腺电切术（TURP）手术使用单极KarlStorz切除设备，使用山梨醇和双极Olympus设备在盐水（TURPis）中经尿道前列腺切除术。使用滚球进行止血。抗凝治疗遵循心脏病专家和传染病专家的规定方案。使用IBM公司进行统计分析2013年发布IBMSPSSStatisticsforWindows,版本22.0。Armonk,纽约：IBM公司
结果：在138名受BPH和COVID-19影响的住院患者中，有18名需要紧急内窥镜检查（特别是TURP或TURPis）以实现止血（图1，2）。尽管保守治疗，这些个体仍表现出持续性血尿。手术的平均持续时间为57.9分钟。与未接受手术的患者相比，接受手术的患者平均住院时间更长，持续时间为10.5天，而持续时间为7.5天，分别。此外,29例因住院期间急性尿潴留或排尿症状恶化，需要插入尿道膀胱导管。这些患者计划在COVID-19发作后进行进一步的泌尿系统评估。在一个由53名患者组成的队列中，他们的数据是可访问的，在COVID前状态和国际前列腺症状评分（IPSS）水平之间进行比较，排尿后残留物(PVR)，和生活质量(QoL)。研究结果表明，COVID前IPSS的平均值为11.6，与COVID相关的值为14.2，差异有统计学意义(p<0.05)。COVID前的平均PVR为42.3cm2，而在COVID-19期间，测量结果为62.5cm2，也表现出显着差异（p<0.05）。此外,QoL显示，COVID-19前平均得分为2.4分，COVID-19相关得分为2.9分，再次显示出统计学意义（p<0.05）。
结论：SARS-CoV-2大流行的爆发在医学领域提出了新的挑战，影响BPH管理方法。通常的做法是延迟治疗慢性BPH，直到病毒感染缓解，以降低相关风险。此外,我们的研究显示，在有严重COVID-19症状的个体中，LUTS的演变更为严重。
方法：这项回顾性研究包括2021年1月至2023年1月在泌尿外科住院的SARS-CoV-2和BPH患者。他们的年龄从57岁到88岁，平均年龄65.4岁。BPH的诊断依赖于由直肠指检组成的诊断三联征,生物标志物（包括前列腺特异性抗原（PSA）和游离PSA，和超声检查，根据测试结果确认了这两个条件。经尿道前列腺电切术（TURP）手术使用单极KarlStorz切除设备，使用山梨醇和双极Olympus设备在盐水（TURPis）中经尿道前列腺切除术。使用滚球进行止血。抗凝治疗遵循心脏病专家和传染病专家的规定方案。使用IBM公司进行统计分析2013年发布IBMSPSSStatisticsforWindows,版本22.0。Armonk,纽约：IBM公司
结果：在138名受BPH和COVID-19影响的住院患者中，有18名需要紧急内窥镜检查（特别是TURP或TURPis）以实现止血（图1，2）。尽管保守治疗，这些个体仍表现出持续性血尿。手术的平均持续时间为57.9分钟。与未接受手术的患者相比，接受手术的患者平均住院时间更长，持续时间为10.5天，而持续时间为7.5天，分别。此外,29例因住院期间急性尿潴留或排尿症状恶化，需要插入尿道膀胱导管。这些患者计划在COVID-19发作后进行进一步的泌尿系统评估。在一个由53名患者组成的队列中，他们的数据是可访问的，在COVID前状态和国际前列腺症状评分（IPSS）水平之间进行比较，排尿后残留物(PVR)，和生活质量(QoL)。研究结果表明，COVID前IPSS的平均值为11.6，与COVID相关的值为14.2，差异有统计学意义(p<0.05)。COVID前的平均PVR为42.3cm2，而在COVID-19期间，测量结果为62.5cm2，也表现出显着差异（p<0.05）。此外,QoL显示，COVID-19前平均得分为2.4分，COVID-19相关得分为2.9分，再次显示出统计学意义（p<0.05）。
结论：SARS-CoV-2大流行的爆发在医学领域提出了新的挑战，影响BPH管理方法。通常的做法是延迟治疗慢性BPH，直到病毒感染缓解，以降低相关风险。此外,我们的研究显示，在有严重COVID-19症状的个体中，LUTS的演变更为严重。
