Nonneuropathic Neuropathic Bladder—Is it Really Nonneuropathic?

No AccessJournal of UrologyPediatric Urology1 Apr 2019Nonneuropathic Neuropathic Bladder—Is it Really Nonneuropathic?This article is commented on by the following:Editorial Comment Sibel Tiryaki, Cenk Eraslan, Tutku Soyer, Cem Calli, Ibrahim Ulman, and Ali Avanoglu Sibel TiryakiSibel Tiryaki *Correspondence: Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Bornova35100 Izmir, Turkey (telephone: 00-90-533-231-11-91; FAX: 00-90-232-390-28-02; email: E-mail Address: [email protected]). Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey More articles by this author , Cenk EraslanCenk Eraslan Department of Radiology, Ege University, Izmir, Turkey More articles by this author , Tutku SoyerTutku Soyer Department Pediatric Surgery, Hacettepe University, Ankara, Turkey More articles by this author , Cem CalliCem Calli Department of Radiology, Ege University, Izmir, Turkey More articles by this author , Ibrahim UlmanIbrahim Ulman Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey More articles by this author , and Ali AvanogluAli Avanoglu Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.09.046AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Hinman syndrome is a rare disease with urodynamic findings and a clinical course resembling neuropathic bladder, without a neuropathic etiology. Diffusion tensor imaging is a special technique of magnetic resonance imaging that has recently been used to evaluate the peripheral nerves but has been demonstrated to be applicable for evaluation of the lumbosacral plexus. We examined the lumbosacral plexus using diffusion tensor imaging, which has not previously been reported in patients with Hinman syndrome. Materials and Methods: The study included 12 patients who fulfilled criteria for Hinman syndrome, with severe bladder dysfunction on urodynamics, renal scarring on scintigraphy and no pathological findings on magnetic resonance imaging. The 12 subjects serving as controls required pelvic or spinal magnetic resonance imaging for reasons other than spinal abnormalities. Evaluation was performed with a 3.0 Tesla magnetic resonance imaging system and 16-channel body coil. Tractography was done to examine the lumbosacral plexus. Fractional anisotropy and mean diffusivity were computed and compared between groups for the right and left plexuses. Results: Mean fractional anisotropy was 0.24 and 0.35 for the right plexus in patients and controls, respectively, and 0.24 and 0.36 for the left plexus. Mean diffusivity was 1.39 for the right and left plexuses in patients, and 1.28 for the right and left plexuses in controls (p <0.001 for all). Conclusions: Our study focusing on the lumbosacral plexus as a possible origin of neuropathy revealed abnormal findings in patients with Hinman syndrome resembling nerve injury series. This is the first known study to provide data showing that Hinman syndrome may have a neuropathic etiology. References 1. : Classification and treatment of functional incontinence in children. BJU Int, suppl., 2000; 85: 37. Google Scholar 2. : Diffusion tensor magnetic resonance imaging and fiber tractography of the sacral plexus in children with spina bifida. J Urol 2014; 192: 927. Link, Google Scholar 3. : Architectural configuration and microstructural properties of the sacral plexus: a diffusion tensor MRI and fiber tractography study. Neuroimage 2012; 62: 1792. Google Scholar 4. : In-vivo imaging of the neuronal network of the lower urinary tract using DTI-fibre tracking—a pilot study. Presented at annual meeting of International Continence Society, Rio de Janeiro, October 20-24, 2014. Google Scholar 5. : Visualization of peripheral nerve degeneration and regeneration: monitoring with diffusion tensor tractography. Neuroimage 2009; 44: 884. Google Scholar 6. : Changes in DTI parameters in the optic tracts of macaque monkeys with monocular blindness. Neurosci Lett 2017; 636: 248. Google Scholar 7. : Evaluation of changes in magnetic resonance diffusion tensor imaging of the bilateral optic tract in monocular blind rats. Int J Dev Neurosci 2017; 59: 10. Google Scholar 8. : Peripheral nerve diffusion tensor imaging as a measure of disease progression in ALS. J Neurol 2017; 264: 882. Google Scholar 9. : Anatomical evaluation of lumbar nerves using diffusion tensor imaging and implications of lateral decubitus for lateral transpsoas approach. Eur Spine J 2017; 26: 2804. Google Scholar 10. : Visualization of lumbar nerves using reduced field of view diffusion tensor imaging in healthy volunteers and patients with degenerative lumbar disorders. Br J Radiol 2017; 90: 20160929. Google Scholar 11. : Tractography of lumbar nerve roots: initial results. Eur Radiol 2011; 21: 1153. Google Scholar 12. : The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society. J Urol 2014; 191: 1863. Link, Google Scholar 13. : Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089. Google Scholar 14. : New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009; 20: 629. Google Scholar 15. : Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol 2014; 10: 982. Google Scholar 16. : Efficacy of transcutaneous electric nerve stimulation (TENS) therapy in overactive non-neurogenic neurogenic bladder (Hinman's syndrome). Pak J Med Sci 2011; 27: 528. Google Scholar 17. : High-intensity, short-term biofeedback in children with Hinman's syndrome (non-neuropathic voiding dyssynergia). J Pediatr Urol 2006; 2: 344. Google Scholar 18. : Non-neurogenic bladder and chronic renal insufficiency in childhood. Pediatr Nephrol 1995; 9: 1. Google Scholar 19. : Urinary tract damage in children who wet. Pediatrics 1974; 54: 143. Google Scholar 20. : The occult neuropathic bladder. J Pediatr Surg 1974; 9: 35. Google Scholar 21. : Functional diseases. In: Encyclopedia of Urology. Edited by . Berlin: Springer-Verlag 1960; vol XII, pp 1-24. Google Scholar 22. : Subclinical neurogenic bladder in children. J Urol 1969; 101: 48. Link, Google Scholar 23. : Disturbances of bladder function associated with emotional states. J Am Med Assoc 1949; 141: 1139. Google Scholar 24. : The occult neurological bladder. J Urol 1971; 105: 733. Link, Google Scholar 25. : Isolated neurogenic dysfunction of the bladder in children with urinary tract infection. J Urol 1971; 106: 151. Link, Google Scholar 26. : Identification of nonneurogenic neurogenic bladder in infants. Urology 2007; 70: 355. Google Scholar 27. : The nonneurogenic neurogenic bladder of early infancy. J Urol 1997; 158: 1281. Link, Google Scholar 28. : Chronic retention of urine in children. J Am Med Assoc 1915; 65: 1709. Google Scholar 29. : Peripheral nerve diffusion tensor imaging: overview, pitfalls, and future directions. J Magn Reson Imaging 2018; 47: 1171. Google Scholar 30. : Partial volume effect as a hidden covariate in DTI analyses. Neuroimage 2011; 55: 1566. Google Scholar No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Study received ethical review board approval (15-12.1/9). Supported by Aliye Uster Foundation (Izmir, Turkey) research scholarship. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byCain M (2019) This Month in Pediatric UrologyJournal of Urology, VOL. 201, NO. 4, (639-639), Online publication date: 1-Apr-2019.Related articlesJournal of Urology4 Apr 2019Editorial Comment Volume 201Issue 4April 2019Page: 802-809 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsurinary bladderneurogenicoveractiveurinary bladderurination disordersAcknowledgmentsHur Hassoy, Department of Public Health, Ege University, assisted with statistical analysis of the data.MetricsAuthor Information Sibel Tiryaki Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey *Correspondence: Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Bornova35100 Izmir, Turkey (telephone: 00-90-533-231-11-91; FAX: 00-90-232-390-28-02; email: E-mail Address: [email protected]). More articles by this author Cenk Eraslan Department of Radiology, Ege University, Izmir, Turkey More articles by this author Tutku Soyer Department Pediatric Surgery, Hacettepe University, Ankara, Turkey More articles by this author Cem Calli Department of Radiology, Ege University, Izmir, Turkey More articles by this author Ibrahim Ulman Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey More articles by this author Ali Avanoglu Department of Pediatric Surgery, Division of Pediatric Urology, Ege University, Izmir, Turkey More articles by this author Expand All No direct or indirect commercial incentive associated with publishing this article. The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Study received ethical review board approval (15-12.1/9). Supported by Aliye Uster Foundation (Izmir, Turkey) research scholarship. Advertisement PDF downloadLoading ...