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[Role of alpha antagonists in uncoordinated micturition syndrome in childhood]
M E Molina Vázquez1, I Somoza Arguibay, M G Palacios
1Servicio de Cirugía Pediátrica, Complejo Hospitalario Universitario La Coruña. memoli92@hotmail.com
Insights
Alpha blockers offer a temporary solution for dysfunctional voiding syndrome in children, showing some improvement but with high recurrence rates. Biofeedback remains the definitive treatment for this common pediatric urologic condition.
Area of Science:
- Pediatric Urology
- Pharmacology
- Urodynamics
Background:
- Dysfunctional voiding syndrome (DVS) involves incomplete bladder emptying due to external sphincter overactivity during micturition.
- Diagnosis relies on electromyography and flowmetry, with biofeedback as the primary treatment.
- Alpha blockers serve as an alternative when biofeedback is unavailable.
Purpose of the Study:
- To evaluate the efficacy of alpha blockers as an alternative therapeutic option for pediatric dysfunctional voiding syndrome compared to biofeedback.
Main Methods:
- A retrospective study of 17 children diagnosed with DVS.
- Data collected included age, symptoms, urologic comorbidities, and pre/post-treatment flowmetry.
- Comparison of outcomes between children treated with alpha blockers and those receiving biofeedback.
Main Results:
- 10 children received alpha blockers (Tamsulosin or Doxazosin), and 5 received biofeedback.
- Alpha blocker treatment showed 70% electromyographic improvement but a 70% recurrence rate.
- Biofeedback resulted in 80% improvement with no recurrence; flowmetry improvements were statistically significant with biofeedback.
Conclusions:
- Alpha blockers are an effective alternative for DVS treatment, providing symptomatic relief.
- However, biofeedback demonstrates superior long-term efficacy and is considered the definitive treatment for DVS.
Introduction:
Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative.
Objective:
To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility.
Material And Methods:
We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback.
Results:
There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness.
Conclusions:
Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.
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