Groutz A, Blaivas J G, Pies C, Sassone A M
Weill Medical College, Cornell University, New York, New York, USA.
Neurourol Urodyn. 2001;20(3):259-68. doi: 10.1002/nau.1003.
Data concerning learned voiding dysfunction (Hinman syndrome; non-neurogenic, neurogenic bladder) in adults are scarce. The present study was conducted to assess the pre-valence and clinical characteristics of this dysfunction among adults referred for evaluation of lower urinary tract symptoms. Learned voiding dysfunction was suggested by a characteristic clinical history and intermittent "free" uroflow pattern and by the absence of any detectable neurological abnormality or anatomic urethral obstruction. A definitive diagnosis was made by the demonstration of typical external urethral sphincter contractions during micturition by EMG or fluoroscopy. A urodynamic database of 1,015 consecutive adults was reviewed. Twenty-one (2%) patients (age, 24-76 years) met our strict criteria of learned voiding dysfunction. Obstructive symptoms were the most common presenting symptoms, followed by frequency, 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 was significantly lower in women than in men. Both detrusor pressure at maximum flow and maximum detrusor pressure during voiding were found to be significantly higher in men than in women. Further differentiation between adult women and men failed to reveal any other clinically significant differences. In conclusion, by strict video-urodynamic criteria, 2% of our patients had learned voiding dysfunction. Other patients, with presumed learned voiding dysfunction, who did not undergo video-urodynamics were not included in the present series. Thus, the prevalence of learned voiding dysfunction among adults referred for evaluation of lower urinary tract symptoms is likely to be even higher.
关于成人获得性排尿功能障碍（欣曼综合征；非神经源性、神经源性膀胱）的数据稀缺。本研究旨在评估因下尿路症状接受评估的成人中这种功能障碍的患病率和临床特征。通过典型的临床病史、间歇性“自由”尿流模式以及不存在任何可检测到的神经异常或解剖性尿道梗阻提示存在获得性排尿功能障碍。通过肌电图或荧光镜检查在排尿期间显示典型的尿道外括约肌收缩来做出明确诊断。回顾了1015例连续成人的尿动力学数据库。21例（2%）患者（年龄24 - 76岁）符合我们关于获得性排尿功能障碍的严格标准。梗阻性症状是最常见的首发症状，其次是尿频、夜尿和尿急。8例（35%）患者有复发性尿路感染，其中7例为女性。所有患者均无任何具有临床意义的上尿路损害。女性的首次感觉容量显著低于男性。发现男性排尿时最大尿流率时的逼尿肌压力和排尿期间的最大逼尿肌压力均显著高于女性。成年女性和男性之间的进一步区分未发现任何其他具有临床意义的差异。总之，按照严格的影像尿动力学标准，我们中有2%的患者存在获得性排尿功能障碍。本系列未纳入其他未接受影像尿动力学检查但推测存在获得性排尿功能障碍的患者。因此，如果将这些患者纳入，因下尿路症状接受评估的成人中获得性排尿功能障碍的患病率可能更高。
