alpha-adrenergic blockade in children with neuropathic and nonneuropathic voiding dysfunction

Purpose: Inadequate bladder emptying is a common urinary dysfunction in chi ldren. The role of alpha-blockers for managing bladder outlet obstruction r emains relatively unexplored in children. Because of the well established i mpact of alpha-blocker therapy in men, we investigated its use for treating inadequate bladder emptying in the pediatric population. Materials and Methods: We treated 17 children 3 to 15 years old with docume nted poor bladder emptying of various etiologies, including dysfunctional v oiding, the Hinman syndrome, the lazy bladder syndrome, posterior urethral valves, myelomeningocele and the prune-belly syndrome, using the alpha-1 ad renergic receptor antagonist, doxazosin. The initial dose of 0.5 to 1.0 mg. nightly was increased according to patient response and as tolerated. Pati ents were followed weekly to monthly by symptomatic history, and urine flow and/or post-void residual urine volume measurement. Two patients with neur ogenic bladder were also followed with cystometrography and leak point pres sure determination. Results: Bladder symptomatology and/or emptying improved in 14 patients (82 %). Ten patients had decreased post-void residual urine during treatment an d in 3 uroflowmetry showed increased maximum flow. Two patients with neurop athic bladder secondary to myelomeningocele had decreased leak point pressu re on alpha-blocker therapy and in 2 with a history of posterior urethral v alves new onset bilateral hydronephrosis completely resolved. Only 1 patien t had mild postural hypotension, which resolved with dose reduction. Conclusions: Selective alpha-blocker therapy seems to be well tolerated in children and appears effective for improving bladder emptying in various pe diatric voiding disorders at short-term followup. Long-term followup and fu rther investigation are warranted to validate the potential role of alpha-b locker therapy in pediatric urinary dysfunction.