An outbreak of Zika virus disease, a self-limiting arbovirus infection involving skin
rash and fever, occurred in Brazil in 2015 and was followed by an increase in newborns
with microcephaly and brain malformations. Although two recent studies reported neurogenic
bladder in children with microcephaly and congenital Zika syndrome (CZS), urologic
evaluation is not yet routine.
To investigate the urological profile of children with microcephaly and CZS.
A descriptive, cross-sectional study conducted with children with microcephaly undergoing
clinical, laboratory, urodynamic and ultrasonographic evaluation at a center for childhood
urinary disorders in Salvador, Bahia, Brazil.
Thirty-three children were evaluated. Mean age was 40.3 ± 3.2 months (range 35–47
months). Twenty-one (63.6%) were female. None urinated voluntarily. Urine stream was
continuous in 22 (66.7%) and intermittent in 3 (9.1%), with no information in 8 cases
(24.2%). Abdominal straining during voiding was absent in 27 (81.8%) and present in
3 (9.1%), with no information in 3 cases (9.1%). Upper urinary tract dilatation was
not detected in any of the 27 ultrasounds performed. Twenty-two urine cultures were
performed, with no cases of bacterial growth. Renal function was normal in all cases
(mean creatinine 0.41 ± 0.1 mg/dl, range 0.29–0.79 mg/dl and urea 20 ± 7 mg/dl, 6–36 mg/dl).
Mean maximum bladder capacity was lower than expected for age: 46.4 ± 25.6 mL range
15–110 mL versus 135.2 ± 6.6 mL, 125.5–153 mL, respectively (p < 0.0001). Sixteen
patients (59.2%) had immature and reflex bladder, 3 (11.1%) had neurogenic bladder
with small bladder compliance, 5 (18.5%) had neurogenic bladder and detrusor overactivity
and 1 (3.7%) had normal bladder capacity and compliance, but urinated with abdominal
straining and a significant residue. Urodynamic evaluation was normal in only two
Most children evaluated had immature and reflex bladder, with no repercussions on
the upper urinary tract. Literature on urological complications in children with microcephaly
is sparse; however, the present results differ from cases of neurogenic bladder in
children with neural tube closure defects. Microcephaly in CZS involves a neurological
and urodynamic pattern very similar to that found in children with cerebral palsy.
Study limitations include the absence of a control group and neurological data with
which to correlate these findings.
Neurogenic bladder in children with CZS-associated microcephaly was much less common
than recently reported. Most patients had no kidney abnormalities, but small bladder
capacity and reflex bladder, with non-significant post-void residual urine.