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Treatment with phenoxybenzamine of upper urinary tract complications caused by intravesical obstruction
Insights
Phenoxybenzamine effectively treated persistent reflux and hydronephrosis in children unresponsive to surgery. This alpha-adrenergic blocker improved bladder outlet resistance and intravesical pressure, preventing the need for urinary diversion.
Area of Science:
- Pediatric Urology
- Pharmacology
Background:
- Reflux and hydronephrosis can persist despite surgical interventions in children.
- Elevated bladder outlet resistance and high intravesical pressure are key findings in refractory cases.
Purpose of the Study:
- To evaluate the efficacy of phenoxybenzamine in children with persistent reflux and hydronephrosis.
- To explore the role of alpha-adrenergic blockade in managing complex bladder dysfunction.
Main Methods:
- Case series of five children with refractory reflux and hydronephrosis.
- Utilized cystomanometry to assess bladder outlet resistance and intravesical pressure.
- Administered phenoxybenzamine (an alpha-adrenergic blocker) for treatment.
Main Results:
- Phenoxybenzamine therapy was successful in all five children.
- Restored upper urinary tract urine passage and unimpaired voiding.
- Prevented the need for urinary diversion in all cases.
Conclusions:
- Phenoxybenzamine is a viable treatment for persistent pediatric reflux and hydronephrosis.
- Alpha-adrenergic blockade can effectively manage bladder outlet obstruction and high intravesical pressure.
- Sympathetic hyperfunction may contribute to bladder complications in these cases.
Abstract:
Five children in whom reflux and progressive hydronephrosis persisted despite multiple surgical attempts or repair are described. In all cases cystomanometry displayed a marked elevation of the bladder outlet resistance combined with high intravesical pressure values. Therapy with phenoxybenzamine, an alpha-adrenergic blocker, was successful in all cases, restoring a free urine passage of the upper urinary tract and unimpaired voiding preventing urinary diversion which has been considered in some of these children. Although there were no signs of bladder neuropathy, a hyperfunction of the sympathetic innervation as acause for bladder complications is discussed.