The COVID-19 pandemic — what have urologists learned?

Abstract

On 11 March 2020, the WHO declared the coronavirus disease 2019 (COVID-19) outbreak a pandemic and COVID-19 emerged as one of the biggest challenges in public health and economy in the twenty-first century. The respiratory tract has been the centre of attention, but COVID-19-associated complications affecting the genitourinary tract are reported frequently, raising concerns about possible long-term damage in these organs. The angiotensin-converting enzyme 2 (ACE2) receptor, which has a central role in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) invasion, is highly expressed in the genitourinary tract, indicating that these organs could be at a high risk of cell damage. The detection of SARS-CoV-2 in urine and semen is very rare; however, COVID-19 can manifest through urological symptoms and complications, including acute kidney injury (AKI), which is associated with poor survival, severe structural changes in testes and impairment of spermatogenesis, and hormonal imbalances (mostly secondary hypogonadism). The effect of altered total testosterone levels or androgen deprivation therapy on survival of patients with COVID-19 was intensively debated at the beginning of the pandemic; however, androgen inhibition did not show any effect in preventing or treating COVID-19 in a clinical study. Thus, urologists have a crucial role in detecting and managing damage of the genitourinary tract caused by COVID-19.

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“…Das bedeutet, der Testosteronspiegel sinkt teilweise bedenklich bei Infizierten. Der Zusammenhang zwischen einer Covid-Erkrankung und einem verminderten Testosteronspiegel geht so weit, dass der Testosteronspiegel von Erkrankten als Marker dient, der anzeigt, ob ein Betroffener hospitalisiert oder sogar auf der Intensivstation behandelt werden wird 9 .…”

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“…In case of low levels of TMPRSS2 on the target cell, the virus is internalized via endocytosis and, after endosomal acidification, S2 is cleaved by the enzymes cathepsins [ 51 ]. Finally, regardless of which of the two mechanisms was followed, the viral RNA is released into the cytoplasm of the host cell [ 52 ].…”

Exploring the potential mechanisms of impairment on genitourinary system associated with coronavirus disease 2019 infection: Bioinformatics and molecular simulation analyses

“…Testosterone has been shown to influence the expression of ACE2 and TMPRSS2, while TMPRSS2 is highly expressed in androgen-dependent prostate cancer cells; therefore, prostate cancer and SARS-CoV-2 may intersect via TMPRSS2 pathway[ [14] , [15] , [16] ]. The effectiveness of ADT in patients with prostate cancer combined with SARS-CoV-2 infection is currently controversial and requires further study[ 17 ].…”