Advertisement

Urological profile of children with microcephaly and congenital zika syndrome

Published:October 13, 2020DOI:https://doi.org/10.1016/j.jpurol.2020.10.011

      Summary

      Introduction

      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.

      Objective

      To investigate the urological profile of children with microcephaly and CZS.

      Study design

      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.

      Results

      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 children (7.4%).

      Discussion

      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.

      Conclusion

      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.

      Keywords

      Abbreviations:

      CZS (Congenital Zika Syndrome), ICCS (International Children's Continence Society), WHO (World Health Organization)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Martines R.B.
        • et al.
        Pathology of congenital Zika syndrome in Brazil: a case series.
        Lancet. 2016; 6736: 1-7
        • Musso D.
        • Ko A.I.
        • Baud D.
        “Zika virus infection — after the pandemic.
        N Engl J Med. 2019; 381: 1444-1457
        • Okumoto O.
        • et al.
        Monitoramento integrado de alterações no crescimento e desenvolvimento relacionadas à infecção plo vírus Zika e outras etiologias infecciosas, até a Semana Epidemiológica 20 de 2018 [Integrated monitoring of changes in growth and development related to Zi.
        Bol. Epidemiológico. Secr. Vigilância em Saúde. Ministério da Saúde. 2018; 49: 1-8
        • Glazier D.B.
        • Cummings K.B.
        • Barone J.G.
        Urodynamic evaluation of profound microcephaly in children.
        Br J Urol. 1997; 80: 825-826
        • Monteiro L.M.C.
        • et al.
        “Neurogenic bladder findings in patients with Congenital Zika Syndrome : a novel condition.
        PloS One. 2018; 13: 1-11
        • Costa Monteiro L.M.
        • et al.
        Neurogenic bladder in the settings of congenital Zika syndrome: a confirmed and unknown condition for urologists.
        J. Pediatr. Urol., no. December. 2018; : 2019
        • Zorrilla C.D.
        • García García I.
        • García Fragoso L.
        • De La Vega A.
        Zika virus infection in pregnancy: maternal, fetal, and neonatal considerations.
        J Infect Dis. 2017; 216 (January): S891-S896
        • Teixeira G.A.
        • Enders B.C.
        • Dantas D.N.A.
        • Carvalho G.A. F. de L.
        • Silva A.N.
        Análise do conceito síndrome congênita pelo Zika vírus. vol. 23. 2018: 4-8
        • Aragao M. de F.V.
        • et al.
        Clinical features and neuroimaging ( CT and MRI ) findings in presumed Zika virus related congenital infection and microcephaly : retrospective case series study.
        BMJ. 2016; 353: 1-10
        • Bauer S.B.
        • Nijman R.J.M.
        • Drzewiecki B.A.
        • Sillen U.
        • Hoebeke P.
        International children ’ s continence society standardization report on urodynamic studies of the lower urinary tract in children. vol. 647. May, 2015: 640-647
        • Wein A.J.
        • Kavoussi L.R.
        • Partin A.W.
        • Peters C.A.
        Campbell-walsh Urology.
        11th ed. Elsevier, Philadelphia2016
        • Sager C.
        • et al.
        Initial urological evaluation and management of children with neurogenic bladder due to myelomeningocele.
        J Pediatr Urol. 2017; 13 (-271271.e5): 271.e1
        • Filler G.
        • Gharib M.
        • Casier S.
        • et al.
        Prevention of chronic kidney disease in spina bifida.
        Int Urol Nephrol. 2011; 44: 817-827
        • Marques F.J.P.
        • et al.
        Children born with congenital Zika syndrome display atypical gross motor development and a higher risk for cerebral palsy.
        J Child Neurol. 2019; 34: 81-85
        • Ventura P.A.
        • Lage M.-L.C.
        • de Carvalho A.L.
        • Fernandes A.S.
        • Taguchi T.B.
        • Nascimento-Carvalho C.M.
        Early gross motor development among Brazilian children with microcephaly born right after Zika virus infection outbreak.
        J Dev Behav Pediatr. 2019; 1
        • Carvalho A.
        • et al.
        Clinical and neurodevelopmental features in children with cerebral palsy and probable congenital Zika.
        Brain Dev. 2019; 41: 587-594
        • de Carvalho A.L.
        • Ventura P.
        • Taguchi T.
        • Brandi I.
        • Brites C.
        • Lucena R.
        Cerebral palsy in children with congenital Zika syndrome: a 2-year neurodevelopmental follow-up.
        J Child Neurol. 2020; 35: 202-207
        • Silva J.A.
        • Alvares R.A.
        • Barboza A.L.
        • et al.
        Lower urinary tract dysfunction in children with cerebral palsy.
        Neurourol Urodyn. 2009; 28: 959-963
        • Gundogdu G.
        • Komur M.
        • Avlan D.
        • et al.
        Relationship of bladder dysfunction with upper urinary tract deterioration in cerebral palsy.
        J Pediatr Urol. 2013; 9: 659-664
        • Ersoz M.
        • Kaya K.
        • Erol S.K.
        • et al.
        Noninvasive evaluation of lower urinary tract function in children with cerebral palsy.
        Am J Phys Med Rehabil. 2009; 88: 735-741