Analysis of the effect of one-stage transurethral prostatectomy for benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.

Clinical study of sacral neuromodulation on non-neurogenic, non-obstructive dysuria / 中华泌尿外科杂志

Objective To summarize the initial treatment experiences of SNM on non-neurogenic,non-obstructive dysuria during short follow-up.Methods From January 2013 to May,2017,28 patients with non-neurogenic,non-obstructive dysuria who were diagnosed by video-urodynamic study (including 20 male patients and 8 female patients;17 patients suffered from urethra sphincter spasm and 11 from idiopathic detrusor weakness) were recruited in our study.All of them received ⅠnterStim sacral neuromodulation treatment.We tried to compare the data (such as frequency in 24 hours,residual urine,dysuria degree,nocturia,average volume and urgency) before operation and the data of short term follow-up after stage Ⅱ implanted pulse generator (IPG) embedded in order to summarize the initial experiences of sacral neuromodulation for non-neurogenic,non-obstructive dysuria.Results All 28patients received stage Ⅰ operation with percutaneous approach to implant a tined lead,11 patients (8 male patients and 3 female patients) finally removed the tined lead because of poor testing effects.17 patients (12 male patients and 5 female patients) choose embedding IPG at the end of stage Ⅰ.Of all these patients,the conversion rate of stage Ⅰ to stage Ⅱ is 60.7％ (17/28),among them,the conversion rate of urethra sphincter spasm is 64.7％ (11/17) and the conversion rate of idiopathic detrusor weakness is 54.5％ (6/11).The follow-up time after stage Ⅱ was16.7 months (10-46 months).The data of voiding frequency in 24 hours,residual urine,dysuria degree,nocturia,urgency,average voiding amount and quality of life (QOL) between baseline (before stage Ⅰ) and at the follow-up time were 16.3 ± 6.1 vs.8.8 ± 4.1 (P =0.000),(43.0 ± 73.4) ml vs.(37.867.1)ml(P=0.178);7.8 ±2.3vs.4.3 ±1.2(P=0.001);4.0± 1.8 vs.2.5 ±1.7(P=0.003),3.1±1.7vs.1.9±1.1(P=0.001),(145.7 ±73.5)ml vs.(189.0±66.4)ml(P=0.48),5.7vs.1.4 (P ＜ 0.05) and 5.4 ± 0.7vs.4.0 ± 1.0 (P =0.000),respectively.During the follow-up period,11 patients satisfied with symptoms relieve without recurrence.Six patients had symptoms recurrence,4/6 patients regain the effects after reprogramming,but two patients remained serious recurrence even after repeated reprogramming(frequency,dysuria and hesitation recurred as before SNM).Conclusions SNM is an effective,safe and minimally invasive procedure for patients with non-neurogenic,non-obstructive dysuria.Primary,non-neurogenic urinary sphincter spasm is a good indication for SNM and had high transfer rate.

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 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 Hinman Syndrome Successfully Treated by Non-Surgical Measures

Hinman syndrome is a condition caused by an incoordination between the detrusor and external urethral sphincter during bladder contraction. Manifestations include day-and-night wetting, residual urine, infected urine, vesicoureteral reflux, christmas-tree shaped bladder-wall change, and upper tract damage without neurologic lesion or anatomical obstruction. Recently, this incoordination was postulated to be due to over-compensation of the external sphincter which compensates the uninhibitory detrusor contraction and pathological persistence of this "detrusor-sphincter dyssynergia" habit after brain cortical maturation. Accordingly, this syndrome is an acquired psychosocial-behavioral problem, reversible by bladder training and does not necessitate surgical intervention. We report a case of nonneurogenic neurogenic bladder who was successfully treated by biofeedback training, anticholinergic drugs and intermittent catheterization.

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.