Morbidity of dysfunctional voiding syndrome

External sphincter dyssynergia in the absence of an identifiable causative neurologic lesion (dysfunctional voiding, Hinman-Allen syndrome, non-neurogenic neurogenic bladder) has been known to cause significant morbidity. To determine the outcomes in this syndrome, we conducted a retrospective study of 37 patients referred for urodynamic studies and subsequently diagnosed with dysfunctional voiding.

After diagnosis, follow-up was conducted through chart review and telephone calls to the primary physicians or the patients.

Follow-up was possible in 27 patients (17 female, 10 male; mean follow-up 49 months, range 4 to 192). The average age at diagnosis was 12 years. Eleven patients developed significant or ongoing morbidity. Ten of these 11 patients underwent 17 operations. Eight patients were cured through medication, behavioral modification, intermittent catheterization, and/or other nonoperative treatments. The remaining 8 patients did not experience significant morbidity but did not have resolution of their symptoms as of their last medical evaluation, and most were lost to follow-up.

Dysfunctional voiding resulted in severe morbidity in 11 (40%) of 27 study patients. Eight patients (30%) were cured using nonoperative, conservative treatments, and 8 (30%) had unresolved symptoms within the follow-up period. Urodynamic studies are essential in the diagnosis of the syndrome but cannot be used to consistently predict outcome.