REVIEW
The effect of COVID-19 on the male genitourinary system Carlo Giulioni 1, Vito Lacetera 1 2
2
Università Politecnica delle Marche-Azienda Ospedaliera Ospedali Riuniti Torrette di Ancona; Azienda Ospedaliera Ospedali Riuniti Marche Nord, Division of Urology, Pesaro.
SUMMARY
Objective. To discuss the impact of COVID-19 and anti-SARS-CoV-2 vaccination on the genitourinary system. Material and methods. A literature search was performed through MEDLINE via PubMed and
Web of Science. Results. SARS-CoV-2 induces cytokine storm in kidney and testis, due to their expression of ACE2 and TMPRSS2. Acute renal failure is a real concern for patients with COVID-19 and the monitoring of its function is mandatory. Even male fertility seems to be affected through sperm cells damage and hormonal profile alteration, although further studies are necessary to ascertain it. Patients treated with intravescical instillation of Bacillus Calmette-Guerin have the same incidence of being affected by COVID-19 and should be strictly monitored due to increased risk of severe complications. COVID-19 vaccination implies rare side effects related to the genitourinary system and lymph node enlargement. To avoid tumor overstaging, diagnostic imaging is not recommended soon after its administration. Conclusions. Kidney and testis are susceptible to SARS-CoV-2 infection. Urologists should be updated on COVID-19 implications on urogenital organs.
KEY WORDS: COVID-19; Urology; Acute kidney injury; Male infertility; SARS-CoV-2..
INTRODUCTION Since Coronavirus disease 2019 (COVID-19) was declared a global public health emergency on 30 January 2020, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has had a noteworthy impact on the global health care industry. As of July 24, 2021, over 192 million confirmed cases of COVID-19 and over 4 million were reported on World Health Organization (WHO) website (1). It is already known that COVID-19 affects the respiratory system in the first instance, causing severe respiratory illness up to acute respiratory distress syndrome (ARDS) (2). SARS-CoV-2 penetrates the cell through its affinity for Angiotensin I converting enzyme 2 (ACE2) receptor and the activation of its S protein via serine protease TMPRSS2 (3). These two proteins are mainly present in alveolar cells, although they may occur in other types of endothelial cells, determining several extrapulmonary dysfunctions. Indeed, sequencing Single-cell RNA, SARS-CoV2 was
reported from several organs, including the heart, ileum, esophagus, bladder, and kidney (4). Besides, Fan et al. demonstrated the high expression of ACE2 in kidney and testis (5). Virus infection and male genitourinary tract involvement have only partially been addressed by current literature. Andrologists and Urologists must be updated on evidence based on the latest research. Therefore, the literature was screened and the main results were summarized in a narrative review.
METHODS Our objective was to perform a narrative review to assess the effect of COVID-19 on the urogenital system. A comprehensive literature search was performed on July 24, 2021, through MEDLINE via PubMed and Web of Science, finding the most discussed topic. The following Medical Subject Headings were used: COVID-19, SARS-COV-2, genitourinary system, acute kidney injury, male infertility, bacillus Calmette-Guérin, and anti-COVID-19 vaccination. Advances in Urological Diagnosis and Imaging - 2021; 4,2
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