{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T14:04:22Z","timestamp":1770213862241,"version":"3.49.0"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Reports"],"abstract":"<jats:p>Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3\u201310 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor\u2013sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management\u2014including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis\u2014led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome.<\/jats:p>","DOI":"10.3390\/pediatric18010020","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T12:46:11Z","timestamp":1770122771000},"page":"20","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Severe Lower Urinary Tract Dysfunction in Otherwise Healthy Children: A Three-Case Series and Narrative Review"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2994-1985","authenticated-orcid":false,"given":"Olivia-Oana","family":"Stanciu","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreea","family":"Moga","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0815-0025","authenticated-orcid":false,"given":"Laura","family":"Balanescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mircea","family":"Andriescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruxandra","family":"Caragata","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu","family":"Balanescu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery and Orthopedics, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"},{"name":"Pediatric Surgery Department, \u201cGrigore Alexandrescu\u201d Clinical Emergency Hospital for Children, 011743 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1016\/j.juro.2014.01.110","article-title":"The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the Standardization Committee of the International Children\u2019s Continence Society","volume":"191","author":"Austin","year":"2014","journal-title":"J. Urol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.juro.2009.12.059","article-title":"The management of dysfunctional voiding in children: A report from the International Children\u2019s Continence Society","volume":"183","author":"Chase","year":"2010","journal-title":"J. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/S0022-5347(06)00305-3","article-title":"The standardization of terminology of lower urinary tract function in children and adolescents: Report from the Standardisation Committee of the International Children\u2019s Continence Society","volume":"176","author":"Hoebeke","year":"2006","journal-title":"J. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kopa\u010d, M. (2024). Pediatric Lower Urinary Tract Dysfunction: A Comprehensive Exploration of Clinical Implications and Diagnostic Strategies. Biomedicines, 12.","DOI":"10.20944\/preprints202403.0678.v1"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Fuentes, M., Figueroa, V., and Burbano, J. (2019). Diagnosis and management of bladder dysfunction in children. Front. Pediatr., 7.","DOI":"10.3389\/fped.2019.00298"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, J., Ren, L., Liu, X., Liu, J., and Ling, Q. (2023). Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms242115517"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.pcl.2012.05.007","article-title":"Functional bladder problems in children: Pathophysiology, diagnosis, and treatment","volume":"59","author":"Franco","year":"2012","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_8","first-page":"913","article-title":"Risk factors for recurrent urinary tract infection and renal scarring in children","volume":"169","author":"Keren","year":"2015","journal-title":"Pediatrics"},{"key":"ref_9","first-page":"e13","article-title":"Recurrent urinary tract infections in children with bladder and bowel dysfunction","volume":"136","author":"Shaikh","year":"2016","journal-title":"Pediatrics"},{"key":"ref_10","first-page":"278","article-title":"Urinary tract infections in young children and infants: Common questions and answers","volume":"102","author":"Veauthier","year":"2020","journal-title":"Am. Fam. Physician"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jpurol.2020.11.006","article-title":"Definitions, indications and practice of urotherapy in children and adolescents: A standardization document of the International Children\u2019s Continence Society (ICCS)","volume":"17","author":"Hussong","year":"2021","journal-title":"J. Pediatr. Urol."},{"key":"ref_12","first-page":"e55684","article-title":"Hinman Syndrome: A Rare Entity with Neurogenic Bladder-Like Symptoms","volume":"16","author":"Gampala","year":"2024","journal-title":"Cureus"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/S0022-5347(17)45077-4","article-title":"Nonneurogenic neurogenic bladder (the Hinman syndrome)\u201415-year follow-up of 14 cases","volume":"136","author":"Hinman","year":"1986","journal-title":"J. Urol."},{"key":"ref_14","unstructured":"Hinman, F., and Baskin, L.S. (2009). Hinman\u2019s Atlas of Pediatric Urologic Surgery, Elsevier. Elsevier Health Sciences."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/nau.22751","article-title":"The standardization of terminology of lower urinary tract function in children and adolescents","volume":"35","author":"Hoebeke","year":"2016","journal-title":"Neurourol. Urodyn."},{"key":"ref_16","first-page":"93","article-title":"Bladder function and non-neurogenic dysfunction in children: Classification and terminology","volume":"63","author":"Hoebeke","year":"1995","journal-title":"Acta Urol. Belg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.jpurol.2010.01.006","article-title":"Non-neurogenic elimination disorders in children","volume":"6","author":"Leclair","year":"2010","journal-title":"J. Pediatr. Urol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1978","DOI":"10.1097\/01.ju.0000085667.05190.ad","article-title":"Trospium Chloride for the Treatment of Detrusor Instability in Children","volume":"170","author":"Miguelez","year":"2003","journal-title":"J. Urol."},{"key":"ref_19","first-page":"898","article-title":"Neurogenic non-neurogenic bladder in childhood: Complications and prognostic factors","volume":"99","author":"Boussetta","year":"2021","journal-title":"Tunis. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s40272-017-0249-x","article-title":"Pharmacotherapy for Pediatric Neurogenic Bladder","volume":"19","author":"Kroll","year":"2017","journal-title":"Paediatr. Drugs"},{"key":"ref_21","first-page":"art17","article-title":"Efficacy and Safety of Trospium Chloride Use in Children with Idiopathic and Neurogenic Detrusor Overactivity: An Overview of Available Data","volume":"4","author":"Board","year":"2011","journal-title":"Urotoday Int. J."},{"key":"ref_22","first-page":"613","article-title":"Urinary incontinence in children","volume":"108","author":"Steuber","year":"2011","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_23","first-page":"99","article-title":"Trospium chloride in children: Dynamic changes of the residual urine symptom during treatment of urination disorders","volume":"5","author":"Danilov","year":"2024","journal-title":"Clin. Rev. Gen. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.4111\/kju.2007.48.10.1058","article-title":"Hinman Syndrome: Long-Term Follow-up of 14 Cases","volume":"48","author":"Lee","year":"2007","journal-title":"Korean J. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1016\/S0022-5347(01)64455-0","article-title":"The Nonneurogenic Neurogenic Bladder of Early Infancy","volume":"158","author":"Jayanthi","year":"1997","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10157-008-0048-3","article-title":"An Infantile Case of Hinman Syndrome with Severe Acute Renal Failure","volume":"12","author":"Chaichanamongkol","year":"2008","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/S1875-9572(10)60058-7","article-title":"Psychogenic Urinary Retention in Children: A Case Report","volume":"51","author":"Wan","year":"2010","journal-title":"Pediatr. Neonatol."},{"key":"ref_28","first-page":"90","article-title":"Persistence and appearance of vesicoureteral reflux\/obstruction following open reimplantation for vesicoureteral reflux","volume":"46","author":"Nerli","year":"2019","journal-title":"J. Sci. Soc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/S0022-5347(05)64391-1","article-title":"Influence of Voiding Dysfunction on the Outcome of Endoscopic Treatment for Vesicoureteral Reflux","volume":"168","author":"Capozza","year":"2002","journal-title":"J. Urol."},{"key":"ref_30","first-page":"815472","article-title":"Bladder Dysfunction and Vesicoureteral Reflux","volume":"2008","year":"2008","journal-title":"Adv. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/S0022-5347(17)47673-7","article-title":"The Role of Dysfunctional Voiding in Failure or Complication of Ureteral Reimplantation for Primary Reflux","volume":"134","author":"Noe","year":"1985","journal-title":"J. Urol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/j.juro.2009.10.039","article-title":"Febrile Urinary Tract Infection After Ureteroneocystostomy: A Contemporary Assessment at a Single Institution","volume":"183","author":"Whittam","year":"2010","journal-title":"J. Urol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1016\/S0022-5347(01)63826-6","article-title":"Voiding dysfunction after bilateral extravesical ureteral reimplantation","volume":"159","author":"Lipski","year":"1998","journal-title":"J. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1016\/S0022-5347(01)62682-X","article-title":"Voiding dysfunction after bilateral extravesical detrusorrhaphy","volume":"160","author":"Minevich","year":"1998","journal-title":"J. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"513854","DOI":"10.1155\/2008\/513854","article-title":"Endoscopic treatment of vesicoureteral reflux with dextranomer\/hyaluronic acid in children","volume":"2008","author":"Cerwinka","year":"2008","journal-title":"Adv. Urol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.eururo.2023.12.005","article-title":"Update and Summary of the European Association of Urology\/European Society of Paediatric Urology Paediatric Guidelines on Vesicoureteral Reflux in Children","volume":"85","author":"Gnech","year":"2024","journal-title":"Eur. Urol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00467-017-3679-3","article-title":"Dysfunctional voiding: The importance of non-invasive urodynamics in diagnosis and treatment","volume":"33","author":"Clothier","year":"2018","journal-title":"Pediatr. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"RIVUR Trial Investigators, Hoberman, A., Greenfield, S.P., Mattoo, T.K., Keren, R., Mathews, R., Pohl, H.G., Kropp, B.P., Skoog, S.J., and Nelson, C.P. (2014). Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux. N. Engl. J. Med., 370, 2367\u20132376.","DOI":"10.1056\/NEJMoa1401811"}],"container-title":["Pediatric Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/1\/20\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T13:15:02Z","timestamp":1770124502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7503\/18\/1\/20"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["pediatric18010020"],"URL":"https:\/\/doi.org\/10.3390\/pediatric18010020","relation":{},"ISSN":["2036-7503"],"issn-type":[{"value":"2036-7503","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}