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.