This form of incontinence is rare. Especially in treatment-refractory cases, special efforts have to go into the detection of possible organic causes.
1- The permanent leaking of small amounts of urine during the day and at night is typical for girls with duplex kidney and ectopic ureter. Malformations of the urethra may also be the cause of organic urinary incontinence.
2- Polyuric renal disease—such as tubulopathies, chronic renal failure, or diabetes insipidus—can also manifest as enuresis. Typically, children awake at night owing to a pronounced sensation of thirst.
3- Neurogenic disorders: In congenital (for example, myelomeningocele/spina bifida) or acquired neoplastic
or inflammatory disorders of the nervous system, the innervation of the bladder is often affected. Occult spinal dysraphisms (for example, spina bifida occulta, tethered cord syndrome, sacral agenesis) often remain undetected for a long time. The clinical features of a neurogenic bladder depend on the location of the lesion and is heterogeneous (for example, pathological residual urine, recurrent urinary tract infections, urinary incontinence, lacking perception of the need to urinate, abnormal uroflowmetry, thickened and trabeculated bladder wall).
4- In the rare “non-neurogenic neurogenic bladder,” (Hinman syndrome), the symptoms resemble those of neurogenic bladder, but no neurological lesion is identified.