Features of the Course of Lower Urinary Tract Symptoms in Men with Benign Prostate Hyperplasia and COVID-19


Yurii Gurzhenko
Volodymyr Spyrydonenko


Nowadays men’s health remains in priority. It is given no less attention than to the cardiovascular disorders and cancer. Low urinary tract symptoms (LUTS) accompany most urological diseases and thus are among the most significant syndromes in urology. The medico-social significance of the syndrome puts the development of protocols for its effective detection and drug treatment with long-term efficacy in a number of priority tasks, stimulating the pharmaceutical industry to search for promising candidates..

Restrictions of COVID-19 Pandemic prevent routine procedures by urologists, prompting them to provide online counseling. Under these circumstances, recommendations were made on the strategy and tactics of treatment of urological diseases during a pandemic, as well as strategic directions in the urology of the future were identified. There is a worldwide consensus among experts on minimizing invasive treatments for benign prostatic hyperplasia (BPH) to maximize the protection of medical personnel from the potential risk of COVID-19 infection, while direct contact with patients is not always possible to avoid.

It is known from scientific sources that, in contrast to 2019, in 2020 there was a tendency of increase the share of hospitalizations for emergency urological conditions as well as the share of critical conditions, requiring the strengthening of anti-epidemic measures. Over the past year the ability of the SARS-CoV-2 virus to increase the severity of LUTS in men with urological pathology was reported. Furthermore the development of severe urogenital symptoms (COVID-19-associated cystitis) with a high content of proinflammatory cytokines not only in blood plasma but also in urine was registered. This allows to include LUTS «de novo» in the complex of symptoms of COVID-19. Physicians should be aware of urogenital manifestations COVID-19 and include verification of bladder dysfunction to diagnostic program.

Strict adherence to WHO and EAU anti-epidemic recommendations and algorithms is extremely important, so we provide online counseling to patients with symptomatic BPH, ensuring the continuity of the specialized treatment process and minimizing direct contact.

The proposed method of treatment of moderate to severe BPH associated LUTS involves tamsulosin monotherapy or in combination with finasteride. The results of the use of tamsulosin hydrochloride in cases of LUTS in BPH indicate that the percentage of acute urinary retention in patients receiving monotherapy is almost similar to that when using combination therapy (tamsulosin + finasteride) and is about 7.0% per year. The obtained data suggest that the observation of patients at a distance can be justified only temporarily, but requires strict adherence to an individually designed treatment plan, which should be based on the guidelines of the Ministry of Health of Ukraine and WHO standards.

The problem of BPH is a very important issue in modern medicine and requires clear treatment algorithms, with different contexts of modern realities, such as the latest data on certain links in the pathogenesis of urinary tract obstruction caused by BPH on the background of COVID-19.


How to Cite
Gurzhenko, Y., & Spyrydonenko, V. (2021). Features of the Course of Lower Urinary Tract Symptoms in Men with Benign Prostate Hyperplasia and COVID-19. Health of Man, (3), 24–30. https://doi.org/10.30841/2307-5090.3.2021.246207
For practicing physicians
Author Biographies

Yurii Gurzhenko, State Institution «Institute of Urology of NAMS of Ukraine»

Yurii M. Gurzhenko,

Department of Sexopathology and Andrology

Volodymyr Spyrydonenko, State Institution «Institute of Urology of NAMS of Ukraine»

Volodymyr V. Spyrydonenko,

Department of Sexopathology and Andrology


European Association of Urology Guidelines. Available from: https:/uroweb.org/guidelines

Ren LL, Wang YM, Wu ZQ, et al. Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study. Chin Med J (Engl). May 2020;5;133(9):1015-24.

Novara G, Checcucci E, Crestani A, Abrate A et al. Telehealth in Urology: A Systematic Review of the Literature. How Much Can Telemedicine Be Useful During and After the COVID-19 Pandemic? Eur Urol. 2020 Dec;78(6):786-811.

Medina-Polo J, Téigell Tobar J, Romero-Otero J, Carballido-Rodríguez J et al. Benign prostatic hyperplasia management during COVID-19 pandemia. Arch Esp Urol. 2020; Jun;73(5):405-12.

Morselli S, Liaci A, Nicoletti R, Pecoraro A, Gemma L et al. The use of a novel smartphone app for monitoring male luts treatment during the COVID-19 outbreak. Prostate Cancer Prostatic Dis . 2020 Dec;23(4):724-6.

Madanelo M, Ferreira C, Nunes-Carneiro D. et al. The impact of the coronavirus disease 2019 pandemic on the utilization of emergency urological services. BJU Int. 2020 Aug;126(2):256-8.

Amparore D, Campi R, Checcucci E et al. Forecasting the Future of Urology Practice: A Comprehensive Review of the Recommendations by International and European Associations on Priority Procedures During the COVID-19 Pandemic. Eur Urol Focus. 2020 Sep 15;6(5):1032-48.

Аlva Pinto AM, Sebastián González M. Endourology and Benign Prostatic Hyperplasia in COVID-19 Pandemic. Int Braz J Urol. 2020 Jul;46(suppl.1):34-8.

Yuen-Chun Teoh J, Lay Keat Ong W, Gonzalez-Padilla D. et al. (UroSoMe Working Group) A Global Survey on the Impact of COVID-19 on Urological Services. Eur Urol. 2020 Aug;78(2):265-75.

Cicerello E, Mangano MS, Cova G, Zordani A. Urological emergency activities during COVID-19 pandemic: Our experience. Arch Ital Urol Androl. 2020 Dec 17;92(4).

Ficarra V, Novara G, Abrate A et al. Urology practice during COVID-19 pandemic. Minerva Urol Nephrol 2020. DOI: 10.23736/S0393-2249.20.03846-1

Gallioli A, Giancarlo A, Lievore E et al. How the COVID-19 Wave Changed Emergency Urology: Results From an Academic Tertiary Referral Hospital in the Epicentre of the Italian Red Zone Urology. 2021 Jan;147:43-9.

Horpynchenko I.I., Hurzhenko Yu.M., Spyrydonenko V.V. Postokovidnyi syndrom v androlohii. Zdorovia Ukrainy. 2021;2:6-8.

Meftahi GH, Jangravi Z, Sahraei H, Bahari Z. The possible pathophysiology mechanism of cytokine storm in elderly adults with COVID-19 infection: the contribution of «inflame-aging». Inflamm Res. 2020 Sep; 69(9):825-39.

Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020 Feb 22;395(10224):565-74.

Yan R, Zhang Y, Li Y, et al. Structural basis for the recognition of the SARSCoV-2 by full-length human ACE2. Science. 2020 Mar 27;367(6485):1444-8.

Chen Y, Guo Y, Pan Y, et al. Structure analysis of the receptor binding of 2019-nCoV. Biochem Biophys Res Commun. 2020 Feb 17;525(1):135-40.

Hanff TC, Harhay MO, Brown TS, et al. Is there an association between COVID-19 mortality and the renin-angiotensin system: a call for epidemiologic investigations. Clin Infect Dis. 2020 Jul 28;71(15):870-4.

Wu Z, Hu R, Zhang C, et al. Elevation of plasma angiotensin II level is a potential pathogenesis for the critically ill COVID-19 patients. Crit Care. 2020 Jun 5;24(1):290.

Mumm JN, Osterman A, Ruzicka M, Stihl C, Vilsmaier T et al. Urinary Frequency as a Possibly Overlooked Symptom in COVID-19 Patients: Does SARSCoV-2 Cause Viral Cystitis? Eur Urol. 2020 Oct;78(4):624-8. DOI: 10.1016/j.eururo.2020.05.013. Epub 2020 May 19

Kaya Y, Kaya C, Kartal T, Tahta T, Tokgöz VY. Could LUTS be early symptoms of COVID-19. Int J Clin Pract. 2021 Mar;75(3):e13850. DOI: 10.1111/ijcp.13850. Epub 2020 Dec 4.

Kashi AH, De la Rosette J, Amini E, Abdi H, Fallah-Karkan M, Vaezjalali M. Urinary Viral Shedding of COVID-19 and its Clinical Associations: A Systematic Review and Meta-analysis of Observational Studies. Urol J. 2020 Sep 5;17(5):433-41.

Lamb LE, Dhar N, Timar R, Wills M, Dhar S, Chancellor MB. COVID-19 inflammation results in urine cytokine elevation and causes COVID-19 associated cystitis (CAC). Med Hypotheses. 2020 Dec;145:110375.

Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection – a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect 2020;9(1):727–32.

Chu KH, Tsang WK, Tang CS, Lam MF, Lai FM, To KF, et al. Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Kidney Int 2005;67(2):698-705.

Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney impairment is associated with inhospital death of COVID-19 patients. Kidney Int. 2020;97(5):829-38.

Zhen L, Ming W, Jiwei Ya, Jie G, Xiang L, Siji S, et al. Caution on Kidney Dysfunctions of COVID-19 Patients (3/19/2020). MedRxiv. 2020 DOI: https://doi.org/10.1101/2020.02.08.20021212

Fan С, Li K, Ding Ya, Lu WL, Wang J. ACE2 Expression in Kidney and Testis May Cause Kidney and Testis Damage After 2019-nCoV Infection. MedRxiv 2020. DOI: https://doi.org/10.1101/2020.02.12.20022418

Montopoli M, Zumerle S, Vettor R, Rugge M, Zorzi M, Catapano CV, et al. Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (n=4532). Ann Oncol 2020, pii: S0923-7534(20)39797-0. DOI: 10.1016/j.annonc.2020.04.479

Androgens May Explain Male Vulnerability to COVID-19. Medscape May 07. 2020. URL: https://www.medscape.com/viewarticle/930128#vp_2

Sivkov AV, Koriakin AV, Siniagin AA, Apolikhin OI, Kaprin AD. Mochepolovaia sistema i COVID-19 nekotorye aspekty Eksperimentalnaia i klinicheskaia urologiia. 2020;(2):18-23.

Wu ZS, Zhang ZQ, Wu S. Focus on the Crosstalk Between COVID-19 and Urogenital Systems. J Urol 2020 Apr 3. DOI: 10.1097/JU.0000000000001068

Peng L, Liu J, Xu W, Luo Q, Chen D, Lei Z, et al. SARS-CoV-2 Can Be Detected in Urine, Blood, Anal Swabs, and Oropharyngeal Swabs Specimens. J Med Virol 2020 Apr 24. DOI: 10.1002/jmv.25936

Gorpinchenko II, Gurzhenko IuN, Klimenko PM, Shuliak AV, Spiridonenko VV. Opyt ispolzovaniya kombinirovannoy terapii DGPZh s primeneniyem preparatov Flosin MR I Prostamol Uno. Novosti meditsiny i farmatsii v mire. 2010;17(340):3-6.

Gorpinchenko II, Gurzhenko IuN, Klimenko PM, Shuliak AV, Spiridonenko VV. Issledovaniye PROSPEKT P (PROStamol: Perspektivy Kombinirovannoy Terapii) pri DGPZh. Health of Man. 2012;1(40):56-62.

Gorpinchenko II, Gurzhenko IuN, Klimenko PM, Shuliak AV, Spiridonenko VV. Opyt ispolzovaniya kombinirovannoy terapii dobrokachestvennoy giperplazii predstatelnoy zhelezy. Issledovaniye PROSPEKT P Materialy konf. «Urologiya i nefrologiya: vchera. segodnya. zavtra». 1-2.11.2012. Kharkov, 209-12 р.

Gorpinchenko II, Gurzhenko IuN, Spiridonenko VV. Issledovaniye PROSPEKT 3 (PROStamol PErspektivy Kombinirovannoy Terapii) dobrokachestvennoy giperpazii predstatelnoy zhelezy. Health of Man. 2014;3(50):12-8.

Matsukawa Y., Takai S., Funahashi Y. et al. Effects of withdrawing a1-blocker from combination therapy with a1-blocker and 5a-reductase inhibitor in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: a prospective and comparative trial using urodynamics. J Urol. 2017;198:905-12.

Matsukawa Y., Takai S., Funahashi Y. et al. Long-term efficacy of a combination therapy with an anticholinergic agent and an a1-blocker for patients with benign prostatic enlargement complaining both voiding and overactive bladder symptoms: a randomized, prospective, comparative trial using a urodynamic study. Neurourol Urodyn. 2017;36:748-54.

Hurzhenko Yu.N., Spyrydonenko V.V. Tradytsiini ta novi aspekty v likuvanni dobroiakisnoi hiperplazii (Za materialamy 11 Pivdenno-Yevropeiskoho mitynhu SEEM Yevropeiskoi asotsiatsii urolohiv. Health of Man. 2015;4(55):10-2.

Davidov MI, Lokshin KL, Gorbunova IS. Incidence of acute urinary retention in patients with prostatic adenoma and 8-year long tamsulosin therapy. Urologiia. 2015 Mar-Apr; (2):74-8, 80-1.

Gacci M, Sebastianelli A, Salvi M, Schiavina R, Brunocilla E, Novara G, De Nunzio C, Tubaro A, Oelke M, Gravas S, Carini M, Serni S. Tolterodine in the Treatment of Male LUTS. Curr Urol Rep. 2015 Sep;16(9):60.

Altarac S. Alpha-adrenergic blockers as a support in the treatment of acute urinary retention. Lijec Vjesn. 2006 Jul-Aug;128(7-8):233-7.

Yu Q, Gratzke C, Wang Y, Wang X, Li B, Strittmatter F, Herlemann A, Wang R, Tamalunas A, Waidelich R, Stief CG, Hennenberg M. New strategies for inhibition of non-adrenergic prostate smooth muscle contraction by pharmacologic intervention. Prostate. 2019 May;79(7):746-56.