Effectiveness of alpha1-adrenergic blockers in boys with low urinary flow rate and urinary incontinence.

BACKGROUND AND PURPOSE: Although alpha blockers have been shown to be effective in treating various types of neuropathic voiding dysfunction in children, the effectiveness of alpha(1) blockers in treating neurologically intact children with voiding dysfunction remains unclear. We investigated the effectiveness of treatment with alpha(1)-adrenergic blockade in boys with low uroflow rate and urinary incontinence.

METHODS

The alpha(1) blocker doxazosin (0.5 to 1.0 mg daily) was administered to 16 boys (mean age, 8.9 +/- 3.4 years) with maximum uroflow rate (Qmax) < 15 mL/s and urinary incontinence. Uroflowmetry and postvoid residual volumes were checked before and 4 weeks after doxazosin treatment. After discontinuation of doxazosin for 2 weeks, videourodynamics and cystoscopy were done in 12 of the 16 boys. Improvement of uroflow was arbitrarily defined as an increase of Qmax >/= 2.5 mL/s. Complete improvement of incontinence was defined as > 90% and partial improvement as 50 to 90% reduction of incontinence episodes. Successful treatment was defined as improvement in uroflow and partial or complete improvement of urinary incontinence. Blood pressure, first-dose phenomenon, and adverse effects were monitored at each visit.

RESULTS

Mean medication and follow-up periods were 24.5 weeks and 33.1 weeks, respectively. Improvement of uroflow was noted in 10 patients (63%). Qmax increased from 12.3 +/- 1.3 mL/s to 16.3 +/- 4.1 mL/s (p = 0.001). Complete and partial improvement of incontinence was noted in 7 and 3 patients, respectively. The mean number of wet nights per week decreased from 4.9 +/- 2.3 to 2.2 +/- 2.5 (p < 0.001). Successful treatment was noted in 8 boys (50%), including 3 of 5 boys with primary bladder neck obstruction, 3 of 4 boys with dysfunctional voiding, and 2 of 4 boys with neuropathic voiding dysfunction of unclassified etiology. There were no significant adverse effects. Decreases of systolic and diastolic blood pressure were negligible.

CONCLUSION

alpha(1) Blockade is effective in the treatment of boys with low uroflow rate and incontinence.