Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies

Kashi, Amir H.; de la Rosette, Jean J. M. C. H.; Amini, Erfan; Abdi, Hamidreza; Fallah-Karkan, Morteza; Vaezjalali, Maryam

Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies

dc.authorid	0000-0002-6308-1763
dc.contributor.author	Kashi, Amir H.
dc.contributor.author	de la Rosette, Jean J. M. C. H.
dc.contributor.author	Amini, Erfan
dc.contributor.author	Abdi, Hamidreza
dc.contributor.author	Fallah-Karkan, Morteza
dc.contributor.author	Vaezjalali, Maryam
dc.date.accessioned	2020-12-16T11:00:47Z
dc.date.available	2020-12-16T11:00:47Z
dc.date.issued	2020
dc.department	İstanbul Medipol Üniversitesi, Uluslararası Tıp Fakültesi, Cerrahi Tıp Bilimleri Bölümü, Üroloji Ana Bilim Dalı
dc.description.abstract	Objectives: To review the current literature on the presence of COVID-19 virus in the urine of infected patients and to explore the clinical features that can predict the presence of COVID-19 in urine.Materials and Methods: A systematic review of published literature between 30th December 2019 and 21st June 2020 was conducted on Pubmed, Google Scholar, Ovid, Scopus, and ISI web of science. Studies investigating urinary viral shedding of COVID-19 in infected patients were included. Two reviewers selected relative studies and performed quality assessment of individual studies. Meta-analysis was performed on the pooled case reports and cohort with a sample size of >= 9.Results: Thirty-nine studies were finally included in the systematic review; 12 case reports, 26 case series, and one cohort study. Urinary samples from 533 patients were investigated. Fourteen studies reported the presence of COVID-19 in the urinary samples from 24 patients. The crude overall rate of COVID-19 detection in urinary samples was 4.5%. Considering case series and cohorts with a sample size of >= 9, the estimated viral shedding frequency was 1.18 % (CI 95%: 0.14 - 2.87) in the meta-analysis. Urinary viral load in most reports were lower than rectal or oropharyngeal samples. In adult patients, urinary shedding of COVID-19 was commonly detected in patients with moderate to severe disease (16 adult patients with moderate or severe disease versus two adult patients with mild disease). In children, urinary viral shedding of COVID-19 was reported in 4 children who all suffered from mild disease. Urinary viral shedding of COVID-19 was detected from day 1 to day 52 after disease onset. The pathogenicity of virus isolated from urine has been demonstrated in cell culture media in one study while another study failed to reveal replication of isolated viral RNA in cell cultures. Urinary symptoms were not attributed to urinary viral shedding.Conclusion: While COVID-19 is rarely detected in urine of infected individuals, infection transmission through urine still remains possible. In adult patients, infected urine is more likely in the presence of moderate or severe disease. Therefore, caution should be exerted when dealing with COVID-19 infected patients during medical interventions like endoscopy and urethral catheterization especially in symptomatic adult patients while in children caution should be exerted regardless of symptoms.
dc.identifier.citation	Kashi, A. H., de la Rosette, J. J. M. C. H., Amini, E., Abdi, H., Fallah-Karkan, M. ve Vaezjalali, M. (2020). Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies. Urology Journal, 17(5), 433-441. https://dx.doi.org/10.22037/uj.v16i7.6248
dc.identifier.doi	10.22037/uj.v16i7.6248
dc.identifier.endpage	441
dc.identifier.issn	1735-1308
dc.identifier.issn	1735-546X
dc.identifier.issue	5
dc.identifier.scopusquality	Q3
dc.identifier.startpage	433
dc.identifier.uri	https://dx.doi.org/10.22037/uj.v16i7.6248
dc.identifier.uri	https://hdl.handle.net/20.500.12511/6093
dc.identifier.volume	17
dc.identifier.wosquality	Q4
dc.indekslendigikaynak	Web of Science
dc.indekslendigikaynak	Scopus
dc.indekslendigikaynak	PubMed
dc.language.iso	en
dc.publisher	Urology and Nephrology Research Centre
dc.relation.ispartof	Urology Journal	en_US
dc.relation.publicationcategory	Diğer
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	COVID19
dc.subject	SARS-Cov2-
dc.subject	Urine
dc.subject	Review
dc.subject	Meta-Analysis
dc.subject	Infection Transmission
dc.title	Urinary viral shedding of COVID-19 and its clinical associations: A systematic review and meta-analysis of observational studies
dc.type	Review Article