( Hinman-Allen syndrome, non neurogenic neuro-bladder, occult neurogenic bladder, functional bladder-sphincter dyssynergy )

Rare. Severe voiding dysfunction of the child due to the functional obstruction of the bladder in the absence of neurologic deficit. The cause of this dysfunction of bladder emptying is neuropsychological. It is an extreme form of the 'elimination syndrome' that may be encountered in children 2 to 6 years old : it combines voiding problems (urinary leaks and urinary tract infections) and digestive signs (sometimes constipation, encopresis): this corresponds generally to transient detrusor-external sphincter dyssynergia due to a bladder immaturity.

The diagnostic criteria of Hinman syndrome are:

• clinical: diurnal enuresis and urinary incontinence; recurrent urinary tract infections; severe chronic constipation and/or encopresis; psychological disorders (abnormal family dynamics)
• radiological: upper urinary tract dilatation and signs of a muscular bladder (trabecular thick-walled bladder)
• urodynamic: detrusor-external sphincter dyssynergia; lack of anatomical barrier to voiding (voiding cystogram: distension of the posterior urethra)
• absence of neurological lesions on neurological examination and spinal MRI.

Treatment:

-        in case of early or moderately severe diagnosis: rehabilitation of micturition, anticholinergics, sometimes intermittent bladder catheterisation

-        severe forms: in addition to the medical treatment, suprapubic urinary diversion, sometimes  bladder augmentation plasty,  Mitrofanoff derivation or nephrectomy.

Anesthetic implications: 

check renal function; increased risk of bladder retention under neuraxial block (caudal or epidural): a bladder catheterisation has to be expected.

References : 

-          Claudon P, Fotso-Kamdem A, Aubert D. 
Critères pronostics du syndrome de Hinman (vessie neurogène non neurogène). Etude multicentrique de 31 cas. 
Progrès en Urologie 2010 ; 20 : 292-300

Updated: March 2019