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

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

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

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

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

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