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alpha-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction
P F Austin1, Y L Homsy, J L Masel
1Department of Urology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, USA.
Insights
Alpha-blocker therapy, specifically doxazosin, effectively improved bladder emptying in 82% of pediatric patients with various voiding dysfunctions. This treatment shows promise for children experiencing inadequate bladder emptying.
Area of Science:
- Pediatric Urology
- Pharmacology
- Urodynamics
Background:
- Inadequate bladder emptying is a prevalent urinary dysfunction in children.
- The use of alpha-blockers for pediatric bladder outlet obstruction is not well-established.
- Alpha-blocker therapy has demonstrated efficacy in adult men with similar conditions.
Purpose of the Study:
- To investigate the efficacy and safety of alpha-blocker therapy for treating inadequate bladder emptying in children.
- To explore the potential of alpha-1 adrenergic receptor antagonists in pediatric urinary dysfunction.
Main Methods:
- Seventeen children (ages 3-15) with poor bladder emptying due to various etiologies received doxazosin.
- Dosing was adjusted based on patient response and tolerance, with regular monitoring of symptoms and urodynamic parameters.
- Specialized assessments like cystometrography were used for patients with neurogenic bladder.
Main Results:
- Significant improvement in bladder emptying and/or symptomatology was observed in 82% of patients.
- Reduced post-void residual urine volume and increased maximum flow rates were noted in several patients.
- Positive outcomes included decreased leak point pressure in neuropathic bladders and resolution of hydronephrosis in posterior urethral valve cases.
Conclusions:
- Selective alpha-blocker therapy appears well-tolerated and effective for improving bladder emptying in diverse pediatric voiding disorders.
- Short-term follow-up suggests a potential role for alpha-blockers in managing pediatric urinary dysfunction.
- Further long-term studies are necessary to fully validate these findings.
Purpose:
Inadequate bladder emptying is a common urinary dysfunction in children. The role of alpha-blockers for managing bladder outlet obstruction remains relatively unexplored in children. Because of the well established impact of alpha-blocker therapy in men, we investigated its use for treating inadequate bladder emptying in the pediatric population.
Materials And Methods:
We treated 17 children 3 to 15 years old with documented poor bladder emptying of various etiologies, including dysfunctional voiding, the Hinman syndrome, the lazy bladder syndrome, posterior urethral valves, myelomeningocele and the prune-belly syndrome, using the alpha-1 adrenergic receptor antagonist, doxazosin. The initial dose of 0.5 to 1.0 mg. nightly was increased according to patient response and as tolerated. Patients were followed weekly to monthly by symptomatic history, and urine flow and/or post-void residual urine volume measurement. Two patients with neurogenic bladder were also followed with cystometrography and leak point pressure determination.
Results:
Bladder symptomatology and/or emptying improved in 14 patients (82%). Ten patients had decreased post-void residual urine during treatment and in 3 uroflowmetry showed increased maximum flow. Two patients with neuropathic bladder secondary to myelomeningocele had decreased leak point pressure on alpha-blocker therapy and in 2 with a history of posterior urethral valves new onset bilateral hydronephrosis completely resolved. Only 1 patient had mild postural hypotension, which resolved with dose reduction.
Conclusions:
Selective alpha-blocker therapy seems to be well tolerated in children and appears effective for improving bladder emptying in various pediatric voiding disorders at short-term followup. Long-term followup and further investigation are warranted to validate the potential role of alpha-blocker therapy in pediatric urinary dysfunction.