Pre‐Existing Nocturia Status Predicts Bladder Symptom Exacerbation Following <scp>COVID</scp> ‐19 Vaccination in Women

Bladder sensory symptoms following COVID-19 vaccination remain underrecognized, particularly in women. Prior surveys have suggested transient storage lower urinary tract symptom (LUTS) changes after vaccination; however, these studies often pooled data across sexes and utilized overactive bladder-oriented instruments that do not capture the “problem/bother” dimension central to interstitial cystitis/bladder pain syndrome (IC/BPS)-like phenotypes [1-3]. We therefore evaluated whether COVID-19 vaccination is associated with measurable changes in IC/BPS-specific symptom and problem indices in women and sought clinical predictors of post-vaccination deterioration. We conducted a cross-sectional, questionnaire-based survey at a Taiwanese vaccination clinic from October 1, 2021 to January 31, 2022. Adult women who had received at least one COVID-19 vaccine dose completed Chinese-validated versions of the Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI) before and after vaccination [4]. General adverse events following Covid-19 vaccination was also documented (Supplementary table 1). Participants with pregnancy or a physician-diagnosed urinary tract infection in the preceding 3 months were excluded. The primary outcome was clinically meaningful deterioration, defined as any increase in ICPI total score after vaccination. Logistic regression was used to identify predictors including baseline nocturia and metabolic comorbidities, given prior links between metabolic risk and female LUTS [5] (Supplementary table 2 and 3). A total of 595 women completed eligible surveys. Post-vaccination, ICSI subscores for frequency, nocturia, urgency, and bladder pain increased significantly, with a modest but significant rise in ICSI total score. Similarly, ICPI subscores for frequency, nocturia, and urgency also increased (Supplementary table 4), though the total change in ICPI was small overall. Notably, 123 women (20.7%) experienced ICPI total score deterioration, indicating worsened patient-perceived bother following vaccination. A small subset (5.2%) reported seeking medical attention for urinary complaints, consistent with real-world signals that urologic adverse effects can occur but are generally uncommon [3]. Baseline nocturia appeared to stratify post-vaccination trajectory. Women with pre-existing nocturia exhibited significantly greater increases in ICPI total score than those without nocturia (Table 1). In multivariable analysis, pre-existing nocturia (adjusted OR 3.53, 95% CI 2.29–5.21) and hyperlipidemia (adjusted OR 3.42, 95% CI 1.24–9.46) independently predicted ICPI deterioration. These findings offer a sex-specific perspective using IC/BPS-relevant instruments [4] and suggest that COVID-19 vaccination may trigger mild but measurable bladder sensory bother in a susceptible subgroup of women. The strong association with pre-existing nocturia provides a pragmatic clinical signal for risk-based counseling and short-term post-vaccination monitoring. Future prospective studies incorporating voiding diaries and inflammatory/metabolic biomarkers may clarify mechanisms and duration of these flares [3, 5]. The authors appreciate the generous support from the National Science and Technology Council of Taiwan, Kaohsiung Medical University Hospital at Kaohsiung Medical University, and Kaohsiung Medical University Regenerative Medicine and Cell Therapy Research Center. This research was funded by National Science and Technology Council of Taiwan (grant number: NSTC 114-2314-B-037-019), and Kaohsiung Medical University University Hospital (grant number: KMUH113-3R53 and KMUH114-4R58). The funders had no role in study design, data collection, analysis, and decision to publush. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request. Table S1: Self-reported bladder-related and general adverse events following COVID-19 vaccination (N = 595). Table S2: Pre- and post-vaccination ICSI/ICPI change of score. *, statistically significant between measurements (p < 0.05). ICPI, interstitial cystitis problem index; ICSI, interstitial cystitis symptoms index, SD, standard deviation. Table S3: Univariable and multivariable analyses of factors associated with ICPI score deterioration after vaccination. *, statistically significant between measurements (p < 0.05). CI, confidence interval; ICPI, interstitial cystitis problem index; LUTS, lower urinary tract symptoms; OR, odds ratio, Ref: reference. Table S4: Patient characteristics and distribution. Table S5: Univariable logistic regression analysis of factors associated with ICSI Score deterioration after COVID-19 vaccination. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.