Hinman Syndrome: A Rare Entity With Neurogenic Bladder-Like Symptoms

TL;DR

Hinman syndrome is a rare condition often mistaken for neurogenic bladder, causing urinary symptoms and requiring careful diagnosis.

Contribution

This case highlights the importance of considering Hinman syndrome in patients with neurogenic bladder-like symptoms and normal neurological exams.

Findings

Hinman syndrome can present with symptoms like enuresis, urinary retention, and UTIs, mimicking neurogenic bladder.

Imaging and VCUG are critical for diagnosing Hinman syndrome when neurological exams are normal.

The case emphasizes the need for a thorough history and imaging to avoid misdiagnosis.

Abstract

Hinman syndrome, as is the case with many other rare conditions, is a disease very commonly under-considered or missed in the diagnosis of patients with the presenting symptoms. Clinical and radiographic manifestations of the condition are easily confused with neurogenic bladder without proper history collection and neurological examination. Patients typically present with symptoms including enuresis, urinary retention, reoccurring urinary tract infections, and encopresis. Imaging often shows hydroureteronephrosis and marked bladder wall thickening. While these signs are characteristic of neurogenic bladder, routine neurologic examinations and MRIs of patients with Hinman syndrome often show normal results, and their condition is currently thought to be an acquired behavioral and psychological disorder, often associated with abnormal family dynamics. We present the case of a 14-year-old boy, who presented to the emergency department with nausea, bilateral flank pain, and urinary retention. The patient had an over seven-year history of recurrent urinary tract infections (UTI) and intermittent encopresis and followed up with different providers. Due to the patient’s extensive history and the failure of previous treatments, he was evaluated for causes of neurogenic bladder, but the MRI of the lumbar spine was normal. Fluoroscopic voiding cystourethrogram (VCUG) was ordered and demonstrated abnormal and trabeculated contour of the urinary bladder with bilateral vesicoureteral reflux consistent with the diagnosis of Hinman syndrome.

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