Non-neuropathic Neuropathic Bladder: Is it Really Non-neuropathic?
Sibel Tiryaki, MD1, Cenk Eraslan, MD1, Tutku Soyer, Associate Professor2, Cem Calli, Professor1, Ibrahim Ulman, Professor1, Ali AVANOGLU, Professor1.
1Ege University, Izmir, Turkey, 2Ege University, Ankara, Turkey.
BACKGROUND: Hinman Syndrome is a confusing rare disease with urodynamic findings and clinical course resembling neuropathic bladder and no neuropathic etiology. Diffusion Tensor Imaging (DTI) is a special MRI technique which has recently been used for peripheral nerves but shown to be feasible for evaluation of lumbosacral plexus. Our aim was to evaluate the lumbosacral plexus using DTI which has never been done for Hinman Syndrome.
METHODS: Patients who fulfill the criteria of Hinman syndrome with severe bladder dysfunction in urodynamics, renal scars in scintigraphies and no pathology in MRI were included in the study. Six patients admitted participating in the study. MRI was performed with 3,0 Tesla MRI system and 16 channel body coil. Tractography was done to evaluate lumbosacral plexus and fractional anisotropy was computed for the right and left plexuses.
RESULTS: Among these 6 patients, 3 had renal insuffieciency. One receives regular dialysis, the other two requires supplemantary treatment. One patient has vesicostomy for severe instability, the others use clean intermittant catheterization to empty their bladders. When urodynamic studies are evaluated, 4 had hyperreflexive, two had fibrotic and one had areflexive bladder. DTI was performed to all but one patient's examination wasn't adequate for calculation. Three patients had asymmetry reminding the previous findings of spina bfida patients. This finding had no relation with urodynamic findings or clinical outcome.
CONCLUSIONS: Technological advancements upgrade our abilities to reveal the pathophisologies of diseases. Our study is the first one which provides data to show that Hinman syndrome may have a neuropathic etiology.
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