COVID-19 Associated Lower Urinary Tract Symptoms in Children

Introduction: SARS-COV-2 is associated with unexpected symptoms. Several studies in adults reported urinary frequency with COVID-19. The aim of this study is to reveal lower urinary tract symptoms associated with COVID-19 (CALUTS) in children.

Patients-methods: All children diagnosed with COVID-19 and associated multisystem inflammatory syndrome in children (MIS-C) between November 2020-June 2021 in our hospital were reviewed and asked for urinary symptoms at the time of or following their disease. The ones reporting symptoms were invited for further evaluation. Parents were inquired for their child's former bladder and bowel function, their symptoms after the diagnosis of COVID-19 or MIS-C, onset and duration of the symptoms, and their current state. They were questioned for the frequency of voiding as well as dysuria, odor, and the presence of incontinence as well as other symptoms of COVID-19. The patients who reported symptoms at the time of inquiry were followed for cessation of symptoms. The parameters age, sex, need for hospitalization and admission to ICU were also compared to the whole group to evaluate the main characteristics of patients with lower urinary tract symptoms.

Results: In total 20 patients (18/216 with acute disease and 2/36 with MIS-C) reported CALUTS (figure). Age and sex distribution were not significantly different from the patients without urinary symptoms (p = 0.777 and p = 0.141 respectively). All were otherwise healthy children with no concomitant chronic diseases other than overactive bladder in two. There were 13 girls and 7 boys. Mean age was 11 years (±5 years). Thirteen of the patients were older than 10 years; however, there were also 3 children under 5 years of age. All parents described a sudden onset of extremely increased urinary frequency and urgency lasting for weeks which disappeared gradually. Median bladder and bowel dysfunction questionnaire (BBDQ) score before COVID-19 was 2.5 (1-18) which increased to a median of 22 (15-29) at the time of the symptoms (p < 0.001). The timing of onset and duration of symptoms were variable and not associated with symptom severity (p = 0.306 and p = 0.450 respectively). Eight patients (40%) reported diarrhea. The duration of diarrhea was limited to less than one week in all.

Conclusions: Our study revealed that SARS-COV-2 can be associated with lower urinary tract symptoms also in children both during the acute phase and MIS-C. Further studies are necessary to understand the etiopathogenesis and prevalence of this unexpected aspect of COVID-19.