Severe Lower Urinary Tract Dysfunction in Otherwise Healthy Children: Report of Three Cases and Review of the Literature

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon but clinically important, often presenting with recurrent urinary tract infections (rUTIs), incontinence, or urinary retention. We report three illustrative cases and integrate a structured narrative review to contextualize diagnostic and therapeutic strategies. Methods: Retrospective review of three children (aged 3–10 years) evaluated at a tertiary pediatric urology center (2018–2024) for severe LUTD with rUTIs and no neuroanatomical or structural abnormalities. Assessment included ultrasound, voiding cystourethrography (VCUG), urodynamics, and cystoscopy. Management combined urotherapy, pelvic floor biofeedback, targeted pharmacotherapy, and, when indicated, continuous antibiotic prophylaxis (CAP) or clean intermittent catheterization (CIC). A structured narrative literature search (1970–2024) was undertaken to compare phenotypes and outcomes. Results: Case 1 (7-year-old male) had detrusor overactivity with reduced capacity and cystoscopic remodeling (deep trabeculations, pseudopolypoid mucosa); symptoms resolved on urotherapy + trospium + biofeedback, with relapse after treatment withdrawal. Case 2 (3-year-old female) exhibited poor compliance, detrusor–sphincter dyssynergia, high post-void residuals, and secondary high-grade VUR, consistent with Hinman syndrome; CAP + trospium + CIC + biofeedback led to durable control of rUTIs. Case 3 (10-year-old male) had hypocontractile detrusor with recurrent retention; α-blockade (tamsulosin) plus biofeedback achieved symptom resolution. Across cases, endoscopic findings correlated with urodynamic phenotypes, and a function-first multimodal approach was effective. Conclusions: Severe functional LUTD can occur in otherwise healthy children and may mimic structural disease. Early phenotyping with noninvasive testing, urodynamics, and selective cystoscopy, followed by structured conservative therapy, can control infections, restore function, and prevent unnecessary surgery and upper tract damage.