Hinman Syndrome - Diagnosis and Management: A Rare Case Report.

Hinman syndrome or non-neurogenic neurogenic bladder is a rare clinical condition which is characterized by non-neurogenic urinary bladder dysfunction. It is a diagnosis of exclusion and patient presents with characteristics of a neurogenic bladder with external sphincter dyssynergia but without evidence of any neurologic alteration. The underlying pathology is not known. Bladder training and medical treatment have been recognized as effective management. However, when there is established damage to the upper urinary system or chronic renal failure, surgery is preferred over conservative treatment. Due to the low incidence of the disease, there is still no consensus for the most adequate treatment or management. We report the case of a pediatric patient presented with recurrent retention of urine with dysfunctional voiding and compromised renal functions. As patient already presented with upper urinary tract damage hence underwent successful surgical treatment for the same.

A Patient with Hinman's Syndrome who Underwent Renal Transplantation Using a Pre-existing Cutaneous Ureterostomy / 대한비뇨기과학회지

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.

Hinman Syndrome: Long Term Follow up of 14 Case / 대한비뇨기과학회지

PURPOSE: Hinman syndrome is the most severe form of nonneurogenic neurogenic bladder causing damage of the upper urinary tract. Fourteen patients with Hinman syndrome followed at our institution were evaluated for their clinical characteristics and prognosis. Here we report the findings of this series of patients for this poorly understood syndrome. MATERIALS AND METHODS: The medical records of 14 patients, 8 boys and 6 girls, diagnosed with Hinman syndrome from March 1993 to June 2006 were reviewed. The mean duration of follow up was 69 months. The ultrasonography, 99(m) Tc-dimercaptosuccinic acid renal scan(DMSA), voiding cystourethrogram(VCUG), and urodynamic study(UDS) results were retrospectively analyzed and efficacy of each treatment method was evaluated based on the medical records on follow up. RESULTS: Hydronephrosis of grade III or greater on ultrasonography and renal scarring of both kidneys on the DMSA renal scan were observed in 12 and 14 patients, respectively. Severe bladder trabeculation and high grade VUR(IV, V) were observed on the VCUG in 14 and 8 patients, respectively. Decreased bladder compliance on the UDS was noted in 13 and detrussor-sphincter dyssynergia(DSD) was observed in eight. Medical treatment was not effective in all 14 cases and six patients who underwent botulinum injection of the bladder were unresponsive to that treatment as well. In spite of conservative treatments such as clean intermittent catheterization(CIC), seven patients eventually underwent bladder augmentations after a mean period of thirty-seven months from diagnosis because of concern about the loss of bladder capacity and renal function. One patient who did not perform CIC progressed to end-stage renal disease and had to be transferred to pediatric nephrology for dialysis. CONCLUSIONS: Patients diagnosed with the Hinman syndrome were treated similar to patients with neurogenic bladder. However, from the long- termfollow up data at our outpatient clinic, many patients eventually had bladder augmentation to prevent further loss of bladder capacity and renal function. Therefore, urologists must not hesitate in performing such treatment when necessary.

A Case of Hinman Syndrome(Nonneurogenic Neurogenic Bladder) / 신경정신의학

OBJECTIVES: The Hinman Syndrome is a condition representing urinary voiding dysfunction in a neurologically intact child. This syndrome probably is an acquired behavioral and psychosocial disorders. We present a case presenting voiding dysfuntion with no neurologic etiology. CASE: The department of urology consulted the department of psychiatry for a psychiatric evaluation of a 14-year-old girl with a history of recurrent urinary tract infections, enuresis, and urinary dribbling since early childhood. She visited the emergency room because of severe abdominal pain and hematuria. She was admitted to the department of urology. Neurological tests showed no abnormality, but a retrograde cystogram showed free vesicoureteral reflux to the level of the dilated intrarenal collecting systems. Marked blunting and dilatation of the calices suggested longstanding urinary flow obstruction. She had a history of separation anxiety disorder and was very competetive, perfectionistic, and nervous. She also had very poor relationships with her friends and had difficulties in managing them. After admission, she had stent operation and cystostomy. Antidepressant and anxiolytic medications with supportive psychotherapy were administered to treat anxiety, tension and depression. Gradually, her depressive symptoms and voiding difficulties improved. CONCLUSIONS: Psychological factors such as a perfectionistic and obsessive personality, a history of severe separation anxiety, stressors from poor interpersonal relationships and the failure of an entrance examination seem to have contributes to the development and exacerbation of the urinary dysfunction. Pharmacotherapy and supportive psychotherapy may be effective in treating associated psychiatric problems of these patients with hinman syndrome.

A case of nonneurogenic neurogenic bladder (Hinman syndrome) / 대한비뇨기과학회지

Nonneurogenic neurogenic bladder is a condition in which the patient is with day and night wetting, infected urine, residual urine, reflux and upper tract damage without neurologic lesion or anatomical obstruction. Recently it is known that some patients with pediatric unstable bladder may contract their external sphincter to inhibit the detrusor contraction and pathological persistence of this "hold on" habit after they master a normal mature pattern of cortical control over the detrusor may result in nonneurogenic neurogenic bladder. The condition is reversible by bladder training with various methods. We report a case of nonneurogenic neurogenic bladder who is treated by self CIC after ileocecocystoplasty because bladder retraining has been failed due to high fever and severe frequency.