Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF/FIOCRUZ), Av. Rui Barbosa, 716, Flamengo, Rio de Janeiro, RJ, Brazil.
UCLA, Department of Medicine, US.
J Pediatr Urol. 2021 Aug;17(4):523.e1-523.e9. doi: 10.1016/j.jpurol.2021.04.005. Epub 2021 Apr 18.
We have previously reported on neurogenic bladder dysfunction among Congenital Zika Vírus Syndrome (CZS) patients, but it is unknown how they will respond to treatment.
To assess whether children with neurological lower urinary tract dysfunction and CZS will respond to Standard therapies.
A prospective observational cohort study of children with CZS referred for urological assessment between 2016 and 2020 to our quaternary center in Brazil. Urological protocol included clinical history, urinalysis and culture, renal and bladder ultrasonography and urodynamic study. Patients were treated based on findings from the first evaluation, with oxybutynin chloride for overactive bladder and low bladder compliance, clean intermittent catheterization for ineffective bladder emptying, or dual therapy when both were observed. Urological outcomes were evaluated between the first and second visits considering patient's adherence. Outcomes measured included clinical, imaging, and urodynamic variables. Data was analyzed using the IBM SPSS 22 software.
From the cohort of 90 patients, 56 completed the second urodynamic assessment and were included. One presented underactive bladder and 55 overactive bladder. Among these 55, 39 were adherent and 16 non-adherents to the prescribed treatment. Among the 39 adherents, 8 adhered regularly to oxybutynin and clean intermittent catheterization (CIC), 29 to oxybutynin alone, and two to catheterization alone. During follow-up, the number of patients with urinary tract infection and postvoid residual increased, but all other parameters had improved. Renal and bladder ultrasonography improved in 10, maximum bladder pressure decreased in 22 and maximum cystometric capacity and compliance increased in 14 patients. Sixteen patients did not adhere regularly to the prescribed treatment and although the number of patients with urinary tract infection reduced with antibiotic therapy, their bladder capacity and compliance did not improve during follow-up.
Ultrasonographic and urodynamic improvements were observed after 10.8 ± 7.5 months of treatment, including one patient with ureterohydronephrosis that resolved. Adherence to CIC remains a challenge and reflected in the number of patients presenting urinary tract infection and postvoid residual. The immediate clinical relevance is the major study strength, given the previously uncharacterized therapy options for this patient population. The number of patients remains one of the study limitations, reducing our ability to perform more advanced statistical analyses.
Patients with Zika-related neurological lower urinary tract dysfunction may benefit from conventional therapies. Results confirmed ultrasonographic and urodynamic improvements after treatment, although not statically significant. Adherence to treatment, specifically to CIC, remains a challenge.
我们之前报道过先天性寨卡病毒综合征（CZS）患者存在神经源性膀胱功能障碍，但尚不清楚他们对治疗的反应如何。
评估神经源性下尿路功能障碍且患有 CZS 的儿童对标准治疗的反应。
这是一项在巴西的四级中心进行的、针对 2016 年至 2020 年间接受泌尿科评估的 CZS 患儿的前瞻性观察队列研究。泌尿科方案包括临床病史、尿液分析和培养、肾脏和膀胱超声以及尿动力学研究。根据首次评估的结果对患者进行治疗，对逼尿肌过度活动和膀胱顺应性低的患者使用氯化羟丁宁，对膀胱排空无效的患者使用间歇性清洁导尿，或在两种情况都存在时使用双重治疗。在考虑患者依从性的情况下，在第一次和第二次就诊之间评估泌尿科结果。评估的结果包括临床、影像学和尿动力学变量。数据使用 IBM SPSS 22 软件进行分析。
在 90 名患者的队列中，有 56 名完成了第二次尿动力学评估并被纳入。1 名患者表现为逼尿肌无力，55 名患者表现为逼尿肌过度活动。在这 55 名患者中，39 名患者对规定的治疗方案有依从性，16 名患者无依从性。在 39 名有依从性的患者中，8 名患者规律地使用了奥昔布宁和间歇性清洁导尿（CIC），29 名患者仅使用奥昔布宁，2 名患者仅使用导尿。在随访期间，尿路感染和残余尿量的患者数量增加，但所有其他参数均有所改善。10 名患者的肾脏和膀胱超声检查得到改善，22 名患者的最大膀胱压力降低，14 名患者的最大膀胱容量和顺应性增加。16 名患者未规律地使用规定的治疗方案，尽管抗生素治疗后尿路感染患者数量减少，但在随访期间他们的膀胱容量和顺应性并未改善。
在 10.8±7.5 个月的治疗后，观察到超声和尿动力学的改善，包括 1 名患有输尿管积水的患者得到缓解。对 CIC 的依从性仍然是一个挑战，这反映在尿路感染和残余尿量的患者数量上。本研究的主要优势是即时的临床相关性，因为之前针对此类患者群体的治疗方案尚未明确。患者数量仍然是研究的局限性之一，降低了我们进行更高级统计分析的能力。
患有寨卡病毒相关神经源性下尿路功能障碍的患者可能受益于常规治疗。治疗后证实了超声和尿动力学的改善，尽管无统计学意义。对治疗的依从性，特别是对 CIC 的依从性，仍然是一个挑战。
