COVID-19 is primarily known for respiratory manifestations, but recent evidence highlights its extrapulmonary effects, including lower urinary tract symptoms (LUTS). This study aims to explore the mechanisms, clinical presentations, and treatment options related to post-COVID-19 LUTS, including COVID-19-associated cystitis (CAC), as an underrecognized component of long COVID.

A narrative review was conducted using PubMed, Scopus, and Web of Science, focusing on studies published between January 2020 and January 2025. Keywords included “COVID-19,” “SARS-CoV-2,” “urinary dysfunction,” and “LUTS.” Articles were included if they described urinary manifestations, pathophysiology, or therapeutic strategies related to SARS-CoV-2 infection. Studies without full-text access or relevance to urological outcomes were excluded. Findings were organized thematically into pathophysiology, clinical features, diagnostics, and management.

LUTS including urgency, frequency, nocturia, and incontinence were commonly reported during both acute and post-acute phases of COVID-19. Over 40% of hospitalized patients experienced persistent urinary symptoms six months after discharge. Pathophysiological mechanisms included bladder inflammation, urothelial ACE2/TMPRSS2 receptor-mediated viral entry, cytokine storms, and autonomic dysfunction. Psychological stress and gut-bladder microbiome interactions may also contribute. Although no standard guidelines exist for CAC, empirical treatment with behavioral strategies, antimuscarinics, and β3-agonists has shown symptomatic relief in many cases.

Post-COVID-19 LUTS represent a significant and often overlooked complication of SARS-CoV-2 infection. While clinical manifestations overlap with other urological disorders, the temporal association with infection and high symptom persistence suggest a distinct post-viral syndrome. Current treatment relies on conventional overactive bladder approaches, but there is a need for targeted clinical protocols. Recognition of CAC is essential for early intervention and improved patient outcomes.

Lower urinary tract symptoms may persist after COVID-19 and significantly affect patients’ quality of life. Recognizing these symptoms as part of long COVID is crucial to guide diagnosis and optimize treatment. Targeted research and standardized management strategies are urgently needed to address this emerging clinical challenge.

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Gomes CM, Hisano M, Souza JD, Henriques JVT, Moromizato J, et al. Lower Urinary Tract Symptoms in a prospective cohort of COVID-19 survivors. Int Braz J Urol. 2024;50:287–95. DOI: 10.1590/S1677-5538.IBJU.2023.0553
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