The non-neurogenic neurogenic bladder (Hinman's syndrome) in children: What are pronostic criteria based on a 31 cases multicentric study

Purpose. To identify in children the pejorative estimated criteria of a extreme dysfunctional voiding can leading to a Hinman syndrome. Patients and methods. Retrospective and multicentric study of 31 patients (19 boys and 12 girls), resulting from three universitary medical center (Besancon, Lyon, Nantes), which were divided into three groups according to their evolution: A forms with a serious uronephrologic outcome. B intermediate forms with persistent voiding dysfunction. C forms with uneventful outcome. Results. The initial urologic examination was done, on average, on 6.4 years old children (1-16) and the diagnosis at 12.2 years (1.8-26.9). Eighty-four percent of the patients presented initial urologic symptoms, including 35% of enuresis and 48% with large amount of stool in the rectal vault (constipation and encopresis in 93%). Thirty-five percent undergoing significant familial life stresses. In group A, urinary incontinence was present in 29%. Sixty-two percent were improved by an intermittent catheterisme and 50% by anticholinergic drugs solely. In group B, 46% presented major constipation or encopresis and 60% an urinary infection. A voiding retraining and an intermittent catheterisme improved 71 and 75% respectively. In group C, no patient presented initial low urinary infection, encopresis or stool impaction. The boys presented more febrile urinary infection (20% vs. 8%), more rectal disorders (encopresis: 31% vs. 8%) and less urinary incontinence. In this group voiding retraining improved 67%. Conclusion. The Hinman's syndrome is a serious and unusual outcome of the "dysfunctional elimination syndrome". At diagnosis, the patterns of a pejorative outcome are the male sex, the severe fecal retention, the serious psychological disorders, the delay of diagnosis and treatment. (C) 2009 Elsevier Masson SAS. All rights reserved.