Article Data

  • Views 379
  • Dowloads 127

Original Research

Open Access

How different strains of COVID-19 affect LUTS in BPH patients?

  • Atanas Ivanov1,*,
  • Petar Antonov1
  • Petar Uchikov2
  • Eleonora Hristova-Atanasova3
  • Gabriela Raycheva4

1Department of urology and general medicine, Medical University-Plovdiv, 4002 Plovdiv, Bulgaria

2Department of special surgery, Medical University-Plovdiv, 4002 Plovdiv, Bulgaria

3Department of social medicine and public health, Medical University-Plovdiv, 4002 Plovdiv, Bulgaria

4Department of clinical oncology, Medical University-Plovdiv, 4002 Plovdiv, Bulgaria

DOI: 10.22514/jomh.2023.030

Submitted: 17 December 2022 Accepted: 27 February 2023

Online publish date: 11 April 2023

*Corresponding Author(s): Atanas Ivanov E-mail:


In late 2019, an outbreak of pneumonia of unknown etiology was reported in Wuhan (China). The causative agent was quickly identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the impact of COVID-19 (coronavirus disease 2019) on various organs and symptoms has been studied, there is still a dearth of data regarding its effect on the genitourinary system. In this study, we investigated the impact of different COVID-19 strains on lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). A total of 69 patients who had previously been infected with COVID-19 from August 2021 to October 2021 and January 2022 to May 2022 were assessed. The two periods were purposively selected based on the dominant COVID-19 variant: the Delta strain for the first period and Omicron for the second, respectively. All patients had BPH and were followed up in two outpatient practices. Demographic information was collected, and LUTS were assessed using the international prostate symptom score (IPSS) questionnaires before and after COVID-19. Ultrasound examinations were performed to determine the prostate gland volume and the post-voided residual (PVR) in each patient. All patients affected by COVID-19 exhibited a worsening of LUTS. The degree of deterioration differed between those infected with different COVID-19 strains. Patients infected with the Delta strain had more severe LUTS than those with the Omicron strain. There is currently limited information available regarding the emerging pathophysiological processes in the urogenital system related to COVID-19. This present study serves as a preliminary investigation into the impact of COVID-19 on LUTS in BPH patients and could serve as a basis for more extensive multicenter studies leading to fundamental discoveries.


COVID-19; BPH; LUTS; Strains

Cite and Share

Atanas Ivanov,Petar Antonov,Petar Uchikov,Eleonora Hristova-Atanasova,Gabriela Raycheva. How different strains of COVID-19 affect LUTS in BPH patients?. Journal of Men's Health. 2023.doi:10.22514/jomh.2023.030.


[1] Bogoch II, Watts A, Thomas-Bachli A, Huber C, Kraemer MUG, Khan K. Pneumonia of unknown aetiology in Wuhan, China: potential for international spread via commercial air travel. Journal of Travel Medicine. 2020; 27: taaa008.

[2] Gorbalenya AE, Baker SC, Baric RS, Groot RJ, Drosten C, Gulyaeva A, et al. The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nature Microbiology. 2020; 5: 536–544.

[3] World Health Organization. Novel Coronavirus (2019-nCoV) Situation Report—22. 2020.

[4] Ebrahim SH, Ahmed QA, Gozzer E, Schlagenhauf P, Memish ZA. COVID-19 and community mitigation strategies in a pandemic. BMJ. 2020; 368: m1066.

[5] Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020; 181: 271–280.e8.

[6] Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 2020; 395: 507–513.

[7] Roehrborn CG. Benign prostatic hyperplasia: an overview. Reviews in Urology. 2005; 9: S3–S14.

[8] Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Madersbacher S, Mamoulakis C, et al. EAU guidelines on the assessment of nonneurogenic male lower urinary tract symptoms including benign prostatic obstruction. European Urology. 2015; 67: 1099–1109.

[9] Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nature Medicine. 2020; 26: 1017–1032.

[10] Perlman S. Another decade, another coronavirus. The New England Journal of Medicine. 2020; 382: 760–762.

[11] Jackson CB, Farzan M, Chen B, Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nature Reviews Molecular Cell Biology. 2022; 23: 3–-20.

[12] Afshari A, Janfeshan S, Yaghobi R, Roozbeh J, Azarpira N. COVID-19 pathogenesis in prostatic cancer and TMPRSS2-ERG regulatory genetic pathway. Infection, Genetics and Evolution. 2021; 88: 104669.

[13] Lucas JM, Heinlein C, Kim T, Hernandez SA, Malik MS, True LD, et al. The androgen-regulated protease TMPRSS2 activates a proteolytic cascade involving components of the tumor microenvironment and promotes prostate cancer metastasis. Cancer Discovery. 2014; 4: 1310–1325.

[14] Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Frontiers of Medicine. 2020; 14: 185–192.

[15] Ren X, Wang S, Chen X, Wei X, Li G, Ren S, et al. Multiple expression assessments of ACE2 and TMPRSS2 SARS-CoV-2 entry molecules in the urinary tract and their associations with clinical manifestations of COVID-19. Infection and Drug Resistance. 2020; 13: 3977–3990.

[16] Mumm J, Osterman A, Ruzicka M, Stihl C, Vilsmaier T, Munker D, et al. Urinary frequency as a possibly overlooked symptom in COVID-19 patients: does SARS-CoV-2 cause viral cystitis? European Urology. 2020; 78: 624–628.

[17] Dhar N, Dhar S, Timar R, Lucas S, Lamb LE, Chancellor MB. De novo urinary symptoms associated with COVID-19: COVID-19-associated cystitis. Journal of Clinical Medicine Research. 2020; 12: 681–682.

[18] Can O, Erkoç M, Ozer M, Karakanli MU, Otunctemur A. The effect of COVID‐19 on lower urinary tract symptoms in elderly men. International Journal of Clinical Practice. 2021; 75: e14110.

[19] Sevim M, Alkiş O, Kartal İG, Coşer Ş, Akman H, Aras B. Impact of COVID-19 on the progression of benign prostatic hyperplasia and aggravation of related symptoms: a prospective study. The Prostate. 2023; 83: 82–86.

[20] Nabeeh H, Ibrahim A, Taha DE, Talaat M, Abdelbaky TM. Impact of COVID-19 pandemic on lower urinary tract symptoms in patients with benign prostatic hyperplasia and predictors of urine retention in such patients. Lower Urinary Tract Symptoms. 2022; 14: 41–46.

[21] 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). Medical Hypotheses. 2020; 145: 110375.

[22] Lal A, Ahmed N, Maqsood A, Alam MK. COVID-19 omicron-another deadly dilemma. Altamash Journal of Dentistry and Medicine. 2022; 1: 1–5.

[23] World Health Organization. Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern. 2021. Available at: https: // (Accessed: 03 December 2021).

[24] Khan K, Karim F, Cele S, San JE, Lustig G, Tegally H, et al. Omicron infection enhances neutralizing immunity against the Delta variant. medRχiv. 2022. [Preprint].

[25] Fisman DN, Tuite AR. Evaluation of the relative virulence of novel SARS-CoV-2 variants: a retrospective cohort study in Ontario, Canada. CMAJ. 2021; 193: E1619–E1625.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Directory of Open Access Journals (DOAJ) DOAJ is a unique and extensive index of diverse open access journals from around the world, driven by a growing community, committed to ensuring quality content is freely available online for everyone.

SCImago The SCImago Journal & Country Rank is a publicly available portal that includes the journals and country scientific indicators developed from the information contained in the Scopus® database (Elsevier B.V.)

Publication Forum - JUFO (Federation of Finnish Learned Societies) Publication Forum is a classification of publication channels created by the Finnish scientific community to support the quality assessment of academic research.

Scopus CiteScore 0.7 (2021) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Norwegian Register for Scientific Journals, Series and Publishers Search for publication channels (journals, series and publishers) in the Norwegian Register for Scientific Journals, Series and Publishers to see if they are considered as scientific. (

Submission Turnaround Time