A UROLOGICAL PROFILE OF CHILDREN WITH MICROCEFALY AND ZIKA VIRUS
Introduction: In 2015, many children were suddenly born with microcephaly caused by the Zika Congenital Syndrome (ZCS). Monteiro et al (Plos One, 2018) evaluated 23 ZCS children, and found neurogenic bladder in all cases through urodynamic studies without rectal catheter. Multiple specialists have followed these children, but urology had not yet been involved until this publication. The objective of this study is to evaluate a ZCS and microcephaly children cohort in order to not only confirm Monteiro et al findings, but to contextualize urodynamic data according to the severity of the condition, concluding the need for urological investigation in such patients. Methodology: A prospective cohort of ZCS microcephaly children was evaluated for urinary symptoms, history of urinary tract infection (UTI), laboratory, ultrasonographic and urodynamic data. Results: 19 patients were evaluated; mean age 38 months (35-41); 10 were female. According to anamnesis, all of them had spontaneous voiding; 4(21%) were committed by intermittent urine stream; 9(47%) had constipation and 7(37%) had a history of febrile UTI, but no evidence through uroculture. All patients underwent urodynamic study: In 15(79%) patients, there was a typical pattern of low bladder capacity and normal pattern reflex voiding. In 4, there was not normal urodynamic study. Two of these presented mild detrusor hyperactivity at the end of the filling and low bladder capacity, but with normal urination. In the other two, there was low complacency associated with low bladder capacity, but both had urination, and in one with a maximum detrusor pressure of 22cmH20 and residue was not significant, while the other with a detrusor pressure of 45cmH20 at the end of cystometry and 30ml post void residue. The mean maximum cystometric capacity (MCC) expected for age was 132.5mL, while the mean value found in the sample was 39.6mL (p<0.001). Conclusion: These findings demonstrate that ZCS microcephaly children have low capacity bladder with immature bladder pattern. Some detrusor hyperactivity, but without clinical significance, was found in 10% of patients. Only one patient presented low bladder complacency with potentially harmful pressures to the kidney and significant post void residue.
ZIKA; CHILDREN; UROLOGY
Escola Bahiana de Medicina - Bahia - Brasil, Universidade Federal da Bahia - Bahia - Brasil
ÂNGELO MEDEIROS FRANCILAIDE CAMPOS, JAMARY FILHO OLIVEIRA, UBIRAJARA OLIVEIRA BARROSO