[The comparative study on selective alpha1-blocker and behavioural therapy in the treatment of discoordinated voiding in children]

Abstract

Purpose: To compare the efficiency of selective alpha1-blocker and behavioural therapy in the treatment of detrusor-sphincter discoordination in children.

Materials: Prospective, randomized study, approval of Ethics Committee, group of 60 children, age: 5 to 17, detrusor-sphincter discoordination. All children had a history of: recurrent UTI, irregular mictions with or without incontinence in "voiding diary". All have normal upper urinary tract in USG. Dicoordination was diagnosed by pathologic uroflowmetry curve and results with significant postvoiding residual urine in USG. Treatment group 1 (n=30): treatment with selective alpha1-blocker (doxazosin) in age related dosage. Group 2 (n=30): behavioral therapy and rehabilitation with conducting "voiding diary" with timed voiding. All children were also instructed on proper toilet posture, relaxation of the pelvic-floor muscles. After 6 weeks: changes in voiding patterns: No. of micturitions/day, average voided volume were estimated. Uroflowmetry was performed and voided volume, Av. flow rate, shape of the curve (1=normal, 2=flatened, irregular, 3=portions), residual urine (10% of Void.vol.) were calculated. Urinalysis and urin culture were obtained.

Results: Of 60 children 57 completed the study: Group 1 (n=30), Group2 (n=27). In Group 1 (alpha1-blocker): improvement in voiding patterns n=21, improvement in UF parameters n=20. In Group 2 (rehabilitation): improvement was estimated in 17 patients. Side effects were noted in 6 children from Group 1 (alpha1-blockers) (headache, hypotonia, vertigo, epistaxis), and non from the Group 2 (rehabilitation).

Conclusions: Both treatment methods seemes to be effective in detrusor-sphincter discoordination. Selective alpha1-blockers alone are more effective than training and rehabilitation exercises.