Hinman Syndrome is a rare disease with urodynamic findings and clinical course that resemble neuropathic bladder and no neuropathic etiology. Diffusion Tensor Imaging (DTI) is a special magnetic resonance imaging (MRI) technique that has recently been used for peripheral nerves but shown to be applicable for evaluation of lumbosacral plexus. Our aim was to evaluate the lumbosacral plexus using DTI, which was not previously performed in Hinman Syndrome.
Twelve patients who fulfill the criteria of Hinman syndrome with severe bladder dysfunction in urodynamics, renal scars in scintigraphies and no pathology in MRI were included in the study were included. Control group consisted of 12 subjects who required pelvic or spinal MRI for reasons other than spinal abnormalities. MRI was performed with 3.0 Tesla MRI system and 16 channel body coil. Tractography was done to evaluate lumbosacral plexus. Fractional anisotropy (FA) and mean diffusivity (MD) were computed and compared between groups for the right and left plexuses.
For patient and control groups, mean FA was 0.24 and 0.35 for right and 0.24 and 0.36 for left plexuses, mean MD was 1.39 and 1.28 both for right and left plexuses respectively (p<0.001 for all).
Our study focusing on the lumbosacral plexus as a possible origin of neuropathy revealed abnormal findings in patients with Hinman syndrome resembling nerve injury studies. It is the first study providing data to show that Hinman syndrome may have a neuropathic etiology.
The Journal of urology. 2018 Sep 21 [Epub ahead of print]
Sibel Tiryaki, Cenk Eraslan, Tutku Soyer, Cem Calli, Ibrahim Ulman, Ali Avanoglu
Ege University, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, Turkey. Electronic address: ., Ege University, Department of Radiology, Izmir, Turkey., Hacettepe University, Department Pediatric Surgery, Ankara, Turkey., Ege University, Department of Pediatric Surgery, Division of Pediatric Urology, Izmir, Turkey.