Introduction and Objectives
Hinman-Allen syndrome is a rare and severe form of dysfunctional voiding mostly represents at school-age and can lead to renal failure. We aimed to compare the upper urinary tract status in a group of moderate-high risk patients with Hinman-Allen syndrome either treated by surgery or conservative therapy in the long-term follow-up.
Material and Methods
We retrospectively reviewed our experience in 67 children with non-neurogenic neurogenic bladder in up to a ten-year period and identified a subset of 22 patients who are at moderate-high risk for upper tract damage. No patients with evidence of a neurologic or obstructive lesion were included in the study. Radiological and urodynamic investigations revealed thick walled bladders with high pressure leading to an increased risk of upper tract deterioration with the absence of neurological disorder in all cases. Group 1 consisted of 8 patients who were surgically treated and group 2 was consisted of 14 patients who were approached conservatively. All patients were followed closely at 3-to-6-month intervals with serial physical examination, upper tract imaging and urine culture.
Results
Mean age on referral was 9.88±3.83 in group-1 and 8.79±3.14 in group-2 (p = 0.267). Mean follow-up was 64.0±25.9 and 52.8±13.4 months (30–120) in group-1 and group-2 respectively (p = 0.365). No significant difference was detected in urinary infection rates between both groups. No patient had new onset hydronephrosis, whereas renal deterioration, defined as cortical thinning or scarring on renal scan was present in 25% and 14.3% in group-1 and group-2 respectively (p > 0.05). Only 1 patient required dialysis in group 2 at the end of follow-up.
Tabled
1
| Group 1 Mean±SD | Group 2 Mean±SD | p value | |
|---|---|---|---|
| Age | 9.88±3.83 | 8.79±3.14 | 0.267 |
| Follow-up (month) | 64.00±25.94 | 52.86±13.44 | 0.365 |
| Asymptomatic UTI (n) | 5.00±3.25 | 2.71±3.00 | 0.070 |
| Symptomatic UTI (n) | 1.00±1.07 | 0.93±1.64 | 0.525 |
| Baseline creatinine (mg/dl) | 1.77±1.55 | 1.20±1.02 | 0.145 |
| Creatinine at the end of follow-up (mg/dl) | 0.93±0.59 | 1.61±2.78 | 0.868 |
Conclusions
The main goal in the treatment of patients with non-neurogenic neurogenic bladder is to preserve upper urinary tract functions. Patients with Hinman-Allen syndrome who are refractory to conservative treatment or present with an advanced pathologic condition may require surgical intervention.We demonstrated that long-term follow-up results of augmentation cystoplasty are plausible and comparable with conservative therapy in moderate-high risk patients.
Article info
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
