Neurogenic bladder findings in patients with Congenital Zika Syndrome: A novel condition

Abstract

Introduction: Congenital Zika Syndrome (CZS) has been associated with microcephaly and other central nervous system abnormalities including areas that have been implicated in the control of the lower urinary tract. As such, this descriptive case series has aimed to investigate whether CZS is linked with neurogenic bladder. Identifying such an association is paramount in the effort to recognize CZS complications that have putative treatment options that could mitigate the impact of CZS in infected children.

Methods: Following IRB approval, urological assessment was performed in all patients referred to our clinic between June 2016 and May 2017 who presented with confirmed CZS-associated microcephaly. The research protocol consisted of obtaining clinical history, laboratory tests, lower and upper urinary tract ultrasounds, as well as a diagnostic urodynamic evaluation. ZIKA virus infection was previously confirmed by maternal history and positive PCR in babies and mothers. Microcephaly and other central nervous system abnormalities were established based on neurological assessment and associated imaging of the central nervous system (CT head and/or Brain MRI).

Results: Twenty-two consecutive CZS patients were tested and confirmed to have neurogenic bladder. Of the 22 patients assessed, 21 presented with an overactive bladder combined with reduced bladder capacity and elevated detrusor filling pressures. Clinically significant increases in postvoid residual (PVR) were confirmed in 40% of cases while a urinary tract infection (UTI) was identified in 23% of cases.

Conclusion: Neurogenic bladder, a known treatable health condition, was confirmed in 100% of patients tested in this study, most presenting with high-risk urodynamic patterns known to lead to renal damage when left untreated. Follow up studies are necessary to provide further insight onto long-term disease progression and to investigate the response to standard therapies for neurogenic bladder. Nonetheless, we emphasize the importance of proactive management of neurogenic bladder and prompt referral so as to help mitigate CZS disease burden for patients and their families.

Fig 1. Urodynamic studies found on CZS patients.

Urodynamic studies showing three different scenarios of overactive bladder found on CZS patients, all with high-risk urodynamic indicators known to cause progressive urinary system damage. A (case 1): Bladder behavior is normal at the beginning but a series of uninhibited detrusor contractions raises the bladder pressure during 2/3 of the filing phase. B (case 2): A very high and sustained inhibited detrusor contraction and a concomitant increased sphincter activity (detrusor-sphincter dyssynergia) raises the intravesical pressure up to 100 cm H₂0. The leak point pressure is equally dangerously high (110 cm H₂0). C (case 3): The repeated inhibited detrusor contractions starting at the very beginning of the filing phase, always followed by leak, severely reduces the bladder capacity.