Neurogenic bladder in the settings of Congenital Zika Syndrome: a confirmed and unknown condition for urologists

Summary Introduction Congenital Zika syndrome (CZS) is a recently discovered condition that affects central nervous system structures that control the lower urinary tract. The first cases of neurogenic bladder (NB) were recently reported as a sequalae of CZS in neurologically impaired children. Objective Our goal is to further evaluate NB in the setting of CZS, identifying urological risk indicators in hopes that early diagnosis will mitigate the impact of the disease. Study design Urological assessment was performed in all patients with CZS and neurological impairment who were referred to our urodynamic clinic between June 2016 and May 2018. Neurogenic bladder was confirmed by urodynamic evaluation, and urological risk was based on urodynamic results. Results Sixty-nine patients with CZS were tested. The majority (63 patients, 91.3%) presented with overactive bladder with increased pressures and reduced capacity for age (table 1). Different urodynamic patterns were observed, and the association of reduced bladder capacity for age, high bladder-filling pressure, and increased postvoid residual were frequently observed. Discussion NB continues to be consistently diagnosed in our cohort of CZS, mostly with high-risk indicators for renal impairment. When not intervened upon in a timely manner, NB can cause progressive damage to the urinary tract, but the lack of knowledge that CZS causes NB delays investigation and treatment. Parents and health professionals will need to be sensitized to the risks that ZIKV can pose to the urinary tract so that appropriate therapies are initiated to prevent irreversible renal damage. Conclusion NB is a common condition among our patients with CZS and microcephaly. This is a new cause of NB, unknown to urologists. While further investigation is necessary to understand long-term disease behavior and therapeutic response, increased knowledge among urologists may help to reduce morbidity related to untreated NB and to mitigate the disease burden for patients and families. Table 1 . Characteristics of the CZS patients and findings at their first urological evaluation, 2016 to 2018 Variables N (%) Mean Total CZS children with urological evaluation 69 (100%) Demographics Gender  F 36 (52%)  M 33 (48%) Age (months old) 13.6 m.o. 29 (42%)  13–23 m.o 40 (58%)  >24 m.o 0 Clinical/urological signs and symptoms  Urinary tract infection 18 (26%)  Constipation 50 (72%)  Abnormal Renal Ultrasound 14 (21%)  Abnormal UDS 69 (100%) UDS Diagnosis  Overactive bladder 63 (91%)  Normal trace with increased BC and/or PVR 6 (9%) Maximum bladder pressure 59.2 cmH 2 O  0 to 40 cmH 2 O 24 (35%)  >40 cmH 2 O 45 (65%) Leak point pressure 75.3 cmH 2 O  0 to 40 cmH 2 O 10 (15%)  >40 cmH 2 O 59 (85%) Bladder compliance 1.1 ml/ cmH 2 O  0–1 ml/ cmH 2 O 42 (61%)  >1 to 4.5 ml/ cmH 2 O 27 (39%) Maximum bladder capacity (MBC) (expressed as % of the expected bladder capacity) 69%  0–50% 33 (48%)  >50–100% 17 (25%)  >100% 19 (27%) PVR (% MBC) 36%  None 26 (38%)  1–10% 3 (4%)  11–50% 21 (30%)  51–100% 19 (28%) UDS, urodynamic study; BC, bladder capacity; PVR, postvoid residual.