Identification of nonneurogenic neurogenic bladder in infants.
OBJECTIVE
To report the third series of the severe neonatal form of Allen-Hinman syndrome. Hinman and Baumann (1973) and Allen (1977) reported the first two series (14 and 21 patients, respectively) of children with severe functional vesicourethral dysfunction producing changes indistinguishable from an obstructive factor.


METHODS
From January 1995 to April 2006, 7 boys with Allen-Hinman syndrome were observed. They had been symptomatic since early infancy with a poor stream and chronic urinary retention. They had bilateral hydroureteronephrosis on renal ultrasonography and intravenous urography (grade 4 to 5 vesicourethral reflux) during the first year of age. They were initially thought by urologists to have a posterior urethral valve. When cystoscopy excluded anatomic obstruction, the urologists were unable to provide an alternative diagnosis.


RESULTS
The patients' age on referral ranged from 5 months to 15 years (mean 6 years). They had been followed up for a period of 2 weeks to 6 years. Four patients had been treated with chronic catheterization and were referred after the age of 5 years with end-stage renal failure. One of them underwent cutaneous vesicotomy after the onset of chronic renal failure and the need for dialysis. I recommended early vesicotomy for the remaining 3 patients. One boy had undergone vesicotomy during the first 6 months of age and had been followed up for 6 years. At 6 years of age, the dilation had disappeared and his renal function had been preserved.


CONCLUSIONS
The nonneurogenic neurogenic bladder represents a rare, severe form of dysfunctional voiding that can present even in the neonatal period and can lead to renal failure.
Al Mosawi
Aamir Jalal
AJ
Department of Pediatrics, Al Kadhimiyia University Hospital, Al Kadimiyia, Baghdad, Iraq. almosawiAJ@yahoo.com
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D013577:Syndrome; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis*