Severe Lower Urinary Tract Dysfunction in Otherwise Healthy Children: A Three-Case Series and Narrative Review

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. Its clinical presentation may closely mimic obstructive or reflux pathology, creating a significant diagnostic pitfall and exposing patients to unnecessary invasive procedures or surgery, with potential risk to the upper urinary tract. Methods: We conducted a descriptive case series of three pediatric patients evaluated at a tertiary pediatric urology center, complemented by a focused narrative review of the literature on severe non-neurogenic LUTD and Hinman syndrome. Clinical data included imaging, cystoscopy, urodynamic evaluation, management strategies, and medium-term follow-up. Results: The three patients (aged 3–10 years) presented with recurrent febrile urinary tract infections, incontinence, or acute urinary retention. Distinct severe functional urodynamic phenotypes were identified: detrusor overactivity with reduced bladder capacity; poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome); and detrusor underactivity with significant post-void residuals. Despite normal neuroanatomy, all patients illustrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid changes. Multimodal conservative management—combining urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, continuous antibiotic prophylaxis or clean intermittent catheterization—resulted in 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 within the non-neurogenic voiding disorder spectrum. Early functional recognition based on urodynamic phenotyping is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment in this population.