- The importance of adrenergic blockers to treat children with neuromuscular dysfunction of the bladder
The importance of adrenergic blockers to treat children with neuromuscular dysfunction of the bladder
Paediatric surgery.Ukraine.2019.3(64):17-21; doi 10.15574/PS.2019.64.17
Zhytomyr Oblast Children’s Clinical Hospital, Stanishevka, Ukraine
Zhytomyr Ivan Franko State University, Ukraine
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
For citation: Shevchuk DV. (2019). The importance of adrenergic blockers to treat children with neuromuscular dysfunction of the bladder. Paediatric Surgery. Ukraine. 3(64): 17-21. doi 10.15574/PS.2019.64.17
Article received: May 27, 2019. Accepted for publication: Sep 12, 2019.
Selective alpha-blockers are widely used in urological practice for the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Safety and efficacy of selective α-blockers in children with neuromuscular dysfunction of bladder noted a number of foreign authors. However, experience with α-blockers for the treatment of dysfunctions of the urinary bladder in children in Ukraine poor.
The aim of the study. To study the safety and efficacy of selective α1-blocker in the treatment of neuromuscular dysfunction of the bladder in children of all ages.
Materials and methods. The safety and efficacy of selective α-blocker doxazosin at a dose of 0.25-1.0 mg/day in the treatment of neuromuscular dysfunction of the bladder in 90 children who were treated in a surgical department No.2 Zhytomyr Oblast Children’s Clinical Hospital were learnt. The age of patients ranged from 1 month to 17 years (mean 4.8 years). The boys were 74 (82.2%), 16 girls (17.8%).
Results. The duration of the drug ranged from 6 months to 3 years. Equipment inspection subject 40 (44.4%) children. In 36 (90%) patients with neuromuscular dysfunction of the bladder were recorded changes in subjective feelings. The noted speaker in urodynamic and ultrasound parameters, indicating improvement Cumulative-evacuation function of the bladder. On the control cystoscopy detected trabekulyarnosti and reducing the number psevdodyvertykuliv.
Conclusions. Thus, the use of selective α-blockers (doxazosin) is safe and quite effective in treatment of neuromuscular dysfunction of the bladder in children. However, without surgical correction causes neuromuscular dysfunction of the bladder, pharmaceuticals monotherapy is inadequate.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of all participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the author.
Key words: children, treatment, bladder, neuromuscular dysfunction of the bladder, α-blockers.
1. Nikitin SS. (2006). The rationale and effectiveness of the combined use of M-cholitics and alpha-blockers in the treatment of children with hyperactive urinary bladder. Abstract of the dissertation candidate of medical science. 14.00.35 pediatric surgery. Moscow: 23.
2. Austin PF, Homsy YL, Masel JL, Cain MP, Casale AJ, Rink RC. (1999, Sep). alpha-Adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction. J Urol. 162 3 Pt 2): 1064-7. https://doi.org/10.1016/S0022-5347(01)68067-4
3. Austin PF. (2009). The role of alpha blockers in children with dysfunctional voiding. The Scientific World JOURNAL: TSW Urology 9: 880–883. https://doi.org/10.1100/tsw.2009.98; PMid:19734961 PMCid:PMC5823122.
4. Cain MP, Wu SD, Austin PF, Herndon CD, Rink RC. (2003, Oct). Alpha blocker therapy for children with dysfunctional voiding and urinary retention. J Urol. 170 4 Pt 2): 1514-5; discussion 1516-7. https://doi.org/10.1097/01.ju.0000085961.27403.4a; PMid:14501648.
5. ClinicalTrials.gov Identifier: NCT00340704)( https://clinicaltrials.gov/ct2/show/study/NCT00340704
6. Donohoe JM, Combs AJ, Glassberg KI. (2005, Jan). Primary bladder neck dysfunction in children and adolescents II: results of treatment with alpha-adrenergic antagonists. J Urol. 173(1): 212-6. https://doi.org/10.1097/01.ju.0000135735.49099.8c; PMid:15592078
7. Gleason DM, Lattimer J. (1962). The pressure-flow study: a method for measuring bladder neck resistance. J Urol. 87: 844–852. https://doi.org/10.1016/S0022-5347(17)65057-2
8. Homsy Y, Arnold P, Zhang W. (2011, Nov). Phase IIb/III dose ranging study of tamsulosin as treatment for children with neuropathic bladder. J Urol. 186(5): 2033-9. https://doi.org/10.1016/j.juro.2011.07.021; PMid:21944133.
9. Jequier S, Rousseau O. (1987). Sonographic measurements of the normal bladder wall in children. AJR Am J Roentgenol. 149: 563–6. https://doi.org/10.2214/ajr.149.3.563; PMid:3303881
10. Kroll P, Gajewska E, Zachwieja J, Sobieska M, Ma.nkowski P. (2016). An Evaluation of the Efficacy of Selective Alpha-Blockers in the Treatment of Children with Neurogenic Bladder Dysfunction –Preliminary Findings. Int J Environ Res Public Health. 13: 321. https://doi.org/10.3390/ijerph13030321; PMid:26999168 PMCid:PMC4808984.
11. Kuo H-C. (2010). The Application of Alpha-adrenergic Receptor Blocker in Lower Urinary Tract Dysfunction that is beyond Benign Prostatic Hyperplasia. Incont Pelvic Floor Dysfunct. 4(3): 73-78.
12. Sidi AA, Dykstra DD, Gonzalez R. (1986, Jan). The value of urodynamic testing in the management of neonates with myelodysplasia: a prospective study. J Urol. 135(1): 90-3. PMID: 3941475. https://doi.org/10.1016/S0022-5347(17)45527-3
13. Tafuro L, Montaldo P, Iervolino LR, Cioce F, Del Gado R. (2009). Ultrasonographic bladder measurements can replace urodynamic study for the diagnosis of non-monosymptomatic nocturnal enuresis. BJU International. 105: 108-111. https://doi.org/10.1111/j.1464-410X.2009.08735.x; PMid:19583728
14. Yucel S, Akkaya E, Guntekin E, Kukul E, Akman S, Melikoglu M, Baykara M. (2005). Can alpha-blocker therapy be an alternative to biofeedback for dysfunctional voiding and urinary retention? A prospective study. The Journal of Urology. 174 4(2): 1612–1615. https://doi.org/10.1097/01.ju.0000179241.99381.5e; PMid:16148665.