What Specimen Urologists Should Be Most Concerned About ? A Systematic Review and Meta-Analysis

  1. M. Reza Roshandel
  2. Masoud Nateqi
  3. Ramin Lak
  4. Pooya Aavani
  5. Reza Sari Motlagh
  6. Tannaz Aghaei Badr
  7. John Sfakianos
  8. Steven A. Kaplan
  9. Shahrokh F. Shariat
  10. Ashutosh K. Tewari

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Abstract

Objective

Investigating the infectivity of body fluid can be useful for preventative measures in the community and ensuring safety in the operating rooms and on the laboratory practices.

Methods

We performed a literature search of clinical trials, cohorts, and case series using PubMed/MEDLINE, Google Scholar, and Cochrane library, and downloadable database of CDC. We excluded case reports and searched all-language articles for review and repeated until the final drafting. The search protocol was registered in the PROSPERO database.

Results

Thirty studies with urinary sampling for viral shedding were included. A total number of 1,271 patients were enrolled initially, among which 569 patients had undergone urinary testing. Nine studies observed urinary viral shedding in urine from 41 patients. The total incidence of urinary SARS-CoV-2 shedding was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively. The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08. The pertaining RR urine compared to blood and stool positive rates were 0.20 and 0.33 respectively.

Conclusions

Our review concludes that not only the SARS-CoV-2 can be excreted in the urine in eight percent of patients but also its incidence may have associations with the severity of the systemic disease, ICU admission, and fatality rates. Moreover, the findings in our review suggest that a larger population size may reveal more positive urinary cases possibly by minimizing biases. However, it is important to notice that it is the naso-pharyngeal specimens, stool, and serum that show more possibilities to became positive, respectively.

Take-home bullet points

  • ❖

    The urinary shedding incidence was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively.

  • ❖

    Urinary shedding may have associations with the severity of the systemic disease, ICU admission, and fatality rates.

  • ❖

    Repeat urinary testing is warranted throughout the disease phases , especially in clinically suspected cases with an initially negative results.

  • ❖

    Technical errors in handling samples, as well as different rRT-PCR methods can be responsible for diversity found in results, in part.

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    1. ScreenIT

      SciScore for 10.1101/2020.10.08.20209544: (What is this?)

      Please note, not all rigor criteria are appropriate for all manuscripts.

      Table 1: Rigor

      Institutional Review Board Statementnot detected.
      Randomizationnot detected.
      Blindingnot detected.
      Power Analysisnot detected.
      Sex as a biological variablenot detected.

      Table 2: Resources

      Software and Algorithms
      SentencesResources
      Literature Search Strategies: A systematic search of the literature was performed in PubMed/MEDLINE, Google Scholar,
      PubMed/MEDLINE
      suggested: None
      Google Scholar
      suggested: (Google Scholar, RRID:SCR_008878)
      Cochrane library, and COVID-19 research articles downloadable database of CDC (Centers for Disease Control and Prevention).
      Cochrane library
      suggested: (Cochrane Library, RRID:SCR_013000)
      Searches were designed to be broad and comprehensive initially, using the following keywords and MeSH terms: (“specimen” or “urine” or “urinary”) and (“corona” or “coronavirus” or “COVID” or “COVID-19” or “COVID-2019” or “SARS” or “SARS-CoV” or “SARS-CoV-2”).
      MeSH
      suggested: (MeSH, RRID:SCR_004750)

      Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

      Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
      Nevertheless, different factors such as the nature of viruses, missing data, design flaws, or methodological limitations might have contributed to these findings. The importance of urinary viral infection should not be ignored in terms of protective measures. We reviewed some important factors that can influence the results. Association Between Severity, Fatality, ICU admission rate, and Sepsis, with Urinary Positivity: COVID severity can be evidenced by the needs for mechanical ventilation, ICU care, as well as higher fatality. Viremia and sepsis are usually representative of more severe forms of diseases and a potential source for viral urinary shedding. In SARS-CoV-1, viremia was reported to be associated with disease severity (61). Similarly, severely ill patients in the setting of SARS-CoV-2 disease may have augmented and prolonged the existence of the virus in blood and other body fluids (10). Furthermore, urinary viral positivity was found in severe cases in a study (7). SARS-CoV-2 viremia also may occur in patients with underlying comorbidities (62). Moreover, the duration of viral RNA excretion in respiratory and stool specimens may be longer in the cases treated with glucocorticoid, an immunosuppressive medication (8, 10). Accordingly, we emphasize the importance of inclusion of severely ill patients and ones with an underlying disease in the shedding studies. In a study with a comparatively higher rate of urinary shedding (9.5%), a significantly higher proportion o...

      Results from TrialIdentifier: No clinical trial numbers were referenced.

      Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

      Results from JetFighter: We did not find any issues relating to colormaps.

      Results from rtransparent:
      • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
      • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
      • No protocol registration statement was detected.

      About SciScore

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    2. Version published to 10.1101/2020.10.08.20209544v3 on medRxiv
    3. Version published to 10.1101/2020.10.08.20209544v2 on medRxiv
    4. Version published to 10.1101/2020.10.08.20209544v1 on medRxiv
    5. Version published to 10.14715/cmb/2020.66.6.26