Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults

Data concerning learned voiding dysfunction (Hinman syndrome; non-neurogeni c, neurogenic bladder) in adults are scarce. The present study was conducte d to assess the pre valence and clinical characteristics of this dysfunctio n among adults referred for evaluation of lower urinary tract symptoms. Lea rned voiding dysfunction was suggested by a characteristic clinical history and intermittent "free" uroflow pattern and by the absence of any detectab le neurological abnormality or anatomic urethral obstruction. A definitive diagnosis was made by the demonstration of typical external urethral sphinc ter contractions during micturition by EMG or fluoroscopy. A urodynamic dat abase of 1,015 consecutive adults was reviewed. Twenty-one (2%) patients (a ge, 24-76 years) met our strict criteria of learned voiding dysfunction. Ob structive symptoms were the most common presenting symptoms, followed by fr equency, nocturia, and urgency. Eight (35%) patients had recurrent urinary tract infections, seven of these being women. None of the patients had any clinically significant upper urinary tract damage. First sensation volume w as significantly lower in women than in men. Both detrusor pressure at maxi mum Row and maximum detrusor pressure during voiding were found to be signi ficantly higher in men than in women. Further differentiation between adult women and men failed to reveal any other clinically significant difference s. In conclusion, by strict video-urodynamic criteria, 2% of our patients h ad learned voiding dysfunction. Other patients, with presumed learned voidi ng dysfunction, who did nor undergo video-urodynamics were not included in the present series. Thus, the prevalence of learned voiding dysfunction amo ng adults referred for evaluation of lower urinary tract symptoms is likely to be even higher. Neurourol. Urodynam. 20:259-268, 2001. (C) 2001 Wiley-L iss, Inc.