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Vesicoureteral reflux and primary bladder neck dysfunction in children: urodynamic evaluation and randomized,
Abdol-Mohammad Kajbafzadeh1, Nima Baradaran, Zhina Sadeghi
1Pediatric Urology Research Center, Pediatric Center of Excellence, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran (IRI). kajbafzd@sina.tums.ac.ir
Insights
Prazosin effectively treats vesicoureteral reflux (VUR) in children with primary bladder neck dysfunction. This condition, often underdiagnosed, benefits from alpha-blocker therapy, improving urodynamic parameters and reflux grade.
Area of Science:
- Pediatric Urology
- Pharmacology
- Urodynamics
Background:
- Primary bladder neck dysfunction is an underdiagnosed cause of pediatric vesicoureteral reflux (VUR).
- Conventional treatments may fail if bladder neck dysfunction is not addressed.
- Urodynamic evaluation is crucial for diagnosing bladder outlet obstruction.
Purpose of the Study:
- To evaluate prazosin's effect on VUR resolution in children with primary bladder neck dysfunction.
- To assess changes in urodynamic parameters following prazosin treatment.
- To determine if prazosin improves outcomes in pediatric VUR patients with this specific condition.
Main Methods:
- 62 children with VUR and primary bladder neck dysfunction were randomized.
- Treatment group received prazosin (0.025 mg/kg) nightly, increasing to two divided doses.
- Placebo group received a placebo. Follow-up included clinical evaluation, uroflowmetry, and urodynamic studies for 12 months.
Main Results:
- Prazosin group showed a 60% decrease in reflux grade versus 17% in placebo.
- Significant reductions in maximal detrusor pressure and post-void residual were observed with prazosin.
- Average flow rate improved significantly in the prazosin group, from 4.30 to 13.10 ml/s over 12 months.
Conclusions:
- Primary bladder neck dysfunction is a critical, underdiagnosed cause of pediatric VUR.
- Promptly addressing bladder neck dysfunction is essential for successful VUR treatment.
- Prazosin is an effective therapy for children with VUR and primary bladder neck dysfunction.
Purpose:
Primary bladder neck dysfunction has been under diagnosed as a treatable cause of vesicoureteral reflux. We evaluated the effect of prazosin administration on vesicoureteral reflux resolution and urodynamic parameters in children with idiopathic primary reflux and primary bladder neck dysfunction.
Materials And Methods:
A total of 62 children (mean ± SD age 7.9 ± 2.4 years) with documented vesicoureteral reflux and urodynamics proved primary bladder neck dysfunction were randomized to receive either 0.025 mg/kg α-blocker (prazosin, 40 patients) or placebo (22) nightly for 1 week with a subsequent increase to 2 divided doses. Patients were followed for 12 months with clinical evaluation and uroflowmetry performed every 2 months, and each patient underwent complete urodynamic study at 6-month intervals.
Results:
In the placebo group no uroflowmetry or urodynamic parameter changed significantly at 1-year followup. A 60% decrease in reflux grade was observed in the treatment group compared to 17% in the placebo group. Mean maximal detrusor pressure, post-void residual and opening time were significantly decreased in both followup sessions in the prazosin group (p <0.05). Average flow rate improved from 4.30 to 12.80 ml per second at 6 months and to 13.10 ml per second at 12 months (both p <0.05).
Conclusions:
Special attention should be given to secondary causes of vesicoureteral reflux (such as primary bladder neck dysfunction, an underdiagnosed entity in children), since conventional treatment will most likely fail if these conditions are not addressed promptly. In this study prazosin was effective therapy for children with vesicoureteral reflux and primary bladder neck dysfunction.
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