Abstract
We report the case of a 4-year-old boy who first presented with acute pyelonephritis
at the age of 6 months. Diagnostic workup revealed high-grade bilateral vesicourethral
reflux (VUR). At the age of 18 months, a bulking agent was used to treat bilateral
VUR. Since the VUR persisted, an open bilateral Lich-Gregoir procedure was done at
the age of 3 years. Immediately after surgery, he developed acute urinary retention
with hydronephrosis that resolved with the placement of dwelling urinary catheter.
After removal of the catheter urinary retention relapsed so placement of suprapubic
urinary catheter was indicated since he did not have sensory loss. He was started
with tamsulosin (α − 1-blocker) and prophylactic antibiotics. Urodynamics were performed
and suggested bladder outlet obstruction. On the basis of previous urethroscopy and
the absence of neurological sequelae, the differential diagnosis of Hinman syndrome
was made. After removal of the suprapubic catheter, clean intermittent catheterization
was started and α-blocker continued. However, magnetic resonance imaging of the brain
and the spinal cord revealed syringohydromyelia extending from thoracic spine (Th5)
to conus medullaris with 6 to 7 mm in diameter. Electromyoneurogram was normal. After
a follow-up of 3 years, the hydronephrosis has resolved. The patient is on clean intermittent
catherization and has no urinary tract infections.
Keywords
neurogenic bladder - syringohydromyelia - vesicourethral reflux
