Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network.

INTRODUCTION: Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE: To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN: Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS: The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION: A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION: A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.

Evaluation of bladder and bowel functions in children with microcephaly and congenital zika syndrome.

INTRODUCTION: Children with Congenital Zika Syndrome (CZS) present structural cortical changes that may compromise the integrity of their connections with urinary and digestive systems, causing bowel and bladder dysfunctions. OBJECTIVE: To evaluate bladder and bowel dysfunction (BBD) in children with CZS. STUDY DESIGN: This is an observational cross-sectional study of a series of CZS cases. Urinary tracts were investigated using a bladder function protocol consisting of clinical history, detailed physical examination, laboratory tests, ultrasound of the lower and upper urinary tracts, and urodynamic evaluation. The bowel function protocol expanded anamnesis with questions related to signs and symptoms of functional disorders, Bristol scale, and ultrasound of the rectal ampoule. RESULTS: Forty children with CZS, aged between one and five years were included. The majority (80%) had bladder and bowel dysfunction (BBD), 12.5% had bladder dysfunction only, and 7.5% only bowel dysfunction. A reduced bladder capacity was confirmed in 36 patients (90%), while 15 (40%) presented postvoid residual greater than 20% of their cystometric capacity. Thirty-five patients (87.5%) presented four signs/symptoms of functional bowel disorders and the rectal ampoule ultrasound was >2.9 cm in 21 (52.5%). Moreover, 19 (47.5%) presented urinary tract infection, while 5 (12.5%) developed pyelonephritis and required hospitalization. Renal ultrasound showed nephrolithiasis in three (7.5%), one (2.5%) presented horseshoe kidney, and a duplicated collecting system was found in three patients. Cryptorchidism was presented in eight (34%). DISCUSSION: Our study confirmed the presence of BBD in 80% of the children with CZS studied in this series. This is the first time that bowel dysfunction is confirmed in the settings of CZS. This recognition will facilitate early identification and appropriate therapies in an attempt to reduce complications. One limitation of the study is the absence of a control group. Due to the new aspects of CZS, it has been difficult to find a suitable group of patients with neurological disorders to compare and performing urodynamic studies in children without neurological or non-neurological voiding dysfunction is unethical. Appropriate control groups for future studies may be children with microcephaly due to other causes or older children with CZS who were not yet investigated or treated. Another limitation is the lack of a standard quantitative evaluation of bowel dysfunction in children with neurological disorders. CONCLUSION: Bladder and bowel dysfunction was confirmed in 80% of the children with CZS. This is a new Zika virus-associated neuromuscular disorder that needs to be further investigated.

Terapia comportamental associada a neuromodulação no tratamento da bexiga e intestino em indivíduos com Parkinson: um estudo piloto / Behavioral therapy associated with neuromodulation in the treatment of bladder and bowel in individuals with Parkinson's: a pilot study

OBJETIVO: O objetivo deste estudo foi avaliar os efeitos da terapia comportamental associada à neuromodulação na bexiga e intestino neurogênicos na Doença de Parkinson. MÉTODOS: Trata-se de um estudo piloto. Os participantes, após assinarem o termo de consentimento, foram submetidos à avaliação das funções eliminatórias, qualidade de vida e estágio da doença por meio de instrumentos específicos. Os sujeitos realizaram dezesseis sessões de neuromodulação parassacral e acompanhamento da terapêutica comportamental. RESULTADOS: Na reavaliação apresentaram melhoras dos sintomas urinários, evacuatórios e dos domínios de qualidade de vida. Foi apresentado também aumento da capacidade vesical que embora não significativos já expressam melhora do quadro clínico expresso pelo paciente. Também observou-se melhora para frequência evacuatória, consistência das fezes e eliminação do esforço para evacuar. CONCLUSÃO: Sugere-se que a neuromodulação acrescida da terapêutica comportamental é uma técnica de baixo custo e com resultados significativos para os sintomas urinários e melhora dos valores de atividade de vida diária, bem-estar emocional, estigma, suporte social, cognição, comunicação e desconforto corporal medidos para qualidade de vida.

AIMS: The study aims to evaluate the effects of behavioral therapy associated with neuromodulation at neurogenic bladder and bowel on Parkinson's disease. METHODS: It is a pilot study. After signing consent forms, the participants had an evaluation of elimination functions, quality of life, and Parkinson's staging through specific instruments. Subjects had sixteen sessions of parasacral neuromodulation and cognitive behavioral therapy attendance. RESULTS: Revaluation showed improvement of urinary and evacuatory symptoms and quality of life domain. There was also an increase in bladder capacity which, although not significant, expresses improvement in the clinical condition expressed by the patient. Improvements at evacuatory frequency, feces consistency, and evacuation strain were also found. CONCLUSION: The study results suggest that neuromodulation associated with behavioral therapy is a low-cost procedure that shows significant results to urinary symptoms and improvements to the quality of life measurements to domains of activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort.

Perfil das mulheres acometidas por prenhez ectópica tubária / Women profile with tubal ectopic pregnancy

A prenhez ectópica é definida como a implantação do óvulo fertilizado em qualquer lugar diferente de sua localização endometrial. É uma séria emergência ginecológica, pois é uma entidade hemorrágica grave. A sua prevalência se elevou significativamente nas últimas décadas e é considerada a primeira causa de morte materna no primeiro trimestre da gestação e a segunda causa de mortalidade materna geral. O principal local da prenhez ectópica é na tuba uterina. Diversos fatores de risco têm sido associados: doença inflamatória pélvica, fumo, idade, paridade, etnia, cirurgias prévias e uso de dispositivo intra-uterino. Foi traçado o perfil das mulheres acometidas por prenhez ectópica, através de um estudo do tipo caso-controle, durante o período de 2000 a 2004, na cidade de Sorocaba (SP), obtendo-se 78 casos de prenhez ectópica e 147 casos de prenhez intra-uterina. A análise estatística revelou como fatores de risco estatisticamente significantes o fumo, a idade e a paridade, todos com p<0,05. Assim sendo, mulheres com mais de 4 gestações, tabagistas e de idade mais avançada, estavam mais propensas a desenvolverem prenhez ectópica. Desta forma, é importante que mulheres em período fértil recebam orientação sobre esses fatores de risco, para que, assim, se possa reduzir a incidência desta patologia.