Abstract
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. 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. 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. 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.
Highlights
Urinary viral shedding can be important from the aspects of diagnosis, vertical and horizontal transmission of infection [1]
The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08
According to our three meta-analyses, stool and blood tests are associated with a significantly higher positive rate than urine (Figures 1-3). These results indicated that when the naso-/oro-pharyngeal SARSCoV-2 test is negative, stool, and/or blood tests are more helpful for virus diagnosis than urine
Summary
Urinary viral shedding can be important from the aspects of diagnosis, vertical and horizontal transmission of infection [1]. There are discrepancies in the reported results of the studies over the SARS CoV-2 urinary shedding, since the viral dynamics are yet to be fully determined, it has been recommended that the urethral or ureteral instrumentation and handling should be carried out cautiously [17]. Considering the stability of SARS-CoV-2 for up to 72 hours [18], performing urological surgeries, or collecting infected urinary samples may put urologists and health care workers at risk [19]. Case Reports Review articles Publications with no original data (e.g. comments, reviews) Non-English publications available to confirm or exclude the possibility of such transmission, CDC advises restricting contact with pets and other animals while one has COVID-19 [27]. We systematically investigated the findings on the urinary SARS-Cov-2 to points out the important methodological considerations needed to be considered in future studies
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