Iraqi Postgraduate Medical Journal

Abstract

ABSTRACT:
BACKGROUND:
Voiding dysfunction is an important problem in chil¬dhood due to its relatively high prevalence and the fact that it may cause upper urinary tract dete¬rioration with renal scarring. Pharmacological therapy is considered as one of the important measures to improve bladder emptying ,Several reports have supported the effectiveness of α-blockers in treating voiding dysfunction in children.
OBJECTIVE:
To evaluate the safety and efficacy of using selective alpha blocker therapy for children with voiding dysfunction.
PATIENTS AND METHODS:
A prospective study conducted from January 2011 to December 2013 in Al- Ramadi teaching hospital. 24 children with mean age 9.9 years had voiding dysfunction. Patients were evaluated by history, clinical examination, laboratory investigations, radiological examination, cystoscopy and urodynamic study. Treatment was initiated with doxazocin (selective α-adrenergic blocker) 0.03 mg/kg body weight and increased according to the response, but not more than 2mg, patients were followed monthly for 12 months.
RESULTS:
24 children (16 patient male and 8 female), all patients had high postvoiding residual volume and abnormally low maximum flow rate. 18 patients (75%) had vesicoureteral reflux and hydronephrosis, after the starting of doxazocin 20 patients (83%) showing improvement in their symptoms. Upper tract dilatation improved in 12 patients (66%), Mean postvoiding residual volume reduced by 72.7% of the pretreatment mean PVR (p = 0.0001),The increment in the maximum flow rate was 68.4% (p 0.0001) from the pretreatment maximum flow rate. Failure rate was reported in 4 patients(16%) subjectively and 6 patient (25%) objectively. No patients was reported to had any serious side effects to doxazocin.
CONCLUSION:
Selective α-blocker therapy seems to be well tolerated in children and appears effective for improving symptoms and bladder emptying in various pediatric voiding disorders.