Zika Virus-Associated Neurogenic Bladder Requires Prompt Management

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The small number of patients in this case series limits the ability to determine whether neurogenic bladder is found in the entire CZS patient population.
The small number of patients in this case series limits the ability to determine whether neurogenic bladder is found in the entire CZS patient population.

Patients with congenital Zika syndrome (CZS) often present with neurogenic bladder. Prompt identification may help reduce the risk for subsequent renal failure and minimize overall disease burden, according to study findings published in PLoS One.

A total of 22 consecutive patients with CZS who presented with confirmed microcephaly were included in the case series study. Investigators collected patients' clinical history, performed laboratory tests, obtained ultrasound scans of the lower and upper urinary tract, and conducted a diagnostic urodynamic evaluation. Positive PCR results from mothers and/or infants and maternal history were used to diagnose Zika virus infection.

In the series, 21 patients presented to the hospital with an overactive bladder and concomitant reduced bladder capacity and elevated detrusor filling pressures. All patients tested had confirmed neurogenic bladder. Up to 40% of cases experienced clinically significant increases in post-void residual (PVR) urine volume. In addition, approximately 23% of cases had a urinary tract infection (UTI) upon admission.

Considering there was no control group in this study — primarily due to the ethics surrounding testing asymptomatic patients — the findings may be limited. In addition, the small number of patients in this case series limits the ability to determine whether neurogenic bladder is found in the entire CZS patient population.

The series investigators believe that patients with CZS should be evaluated for neurogenic bladder as “prompt diagnosis and proactive management of neurogenic bladder within the first year of life will prevent UTIs, urinary incontinence, and deterioration of renal function,” particularly since a narrow window of opportunity exists for preventative and proactive treatment of the disorder.

Reference

Costa Monteiro LM, Cruz GNO, Fontes JM, et al. Neurogenic bladder findings in patients with congenital Zika syndrome: A novel condition. PLoS One. 2018;13(3):e0193514.

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