[Sphincter reeducation in non-coordinated urination syndrome]

The bladder re-education programs were initially associated with treatment of women with vesical instability. However, little has been published on the efficiency of the re-education techniques in the uncoordinated voiding syndrome of the Hinman syndrome. This study evaluated the urodynamic results of sphincter re-education in the treatment of the uncoordinated voiding syndrome.

Our series comprised 50 consecutive patients with uncoordinated voiding syndrome. The mean age was 11.9 years; 82% were females and 18% males. All patients underwent a complete urodynamic study with external perineal electromyography and videocystography. The sphincter re-education protocol was comprised of a manual pre-voiding training phase, an electromyographic pre-voiding training phase and a voiding training phase. Upon completing the re-education process, a new urodynamic study was performed and during the follow-up period, uroflowmetry studies were carried out with external perineal electromyography at 3, 6 and 12 months. Based on the response of the detrusor during voiding, we have classified the uncoordinated voiding syndrome into three types: type A, in which voiding is achieved through voluntary contraction of the detrusor; and type C, in which voiding is achieved through abdominal pressure.

The clinical results obtained by sphincter re-education at one-year follow-up were: 42% cured, 22% improved, 2% relapsed and 14% showed no response. The remaining 20% were excluded from the treatment protocol.

It is likely that the three types of the uncoordinated voiding syndrome are merely different physiopathological stages of the same vesico-urethral dysfunction. We consider sphincter re-education to be the treatment of choice for this type of patients.