Yang Stephen Shei-Dei, Wang Chung-Cheng, Chen Yung-Tai
Department of Urology, En Chu Kong Hospital, Medical College of National Taiwan University, Taipei.
J Formos Med Assoc. 2003 Aug;102(8):551-5.
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.
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.
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.
alpha(1) Blockade is effective in the treatment of boys with low uroflow rate and incontinence.
尽管α受体阻滞剂已被证明可有效治疗儿童各种类型的神经性排尿功能障碍，但α1受体阻滞剂治疗神经功能正常的排尿功能障碍儿童的有效性仍不明确。我们研究了α1-肾上腺素能阻滞剂治疗低尿流率和尿失禁男孩的有效性。
对16名最大尿流率（Qmax）<15 mL/s且有尿失禁的男孩（平均年龄8.9±3.4岁）给予α1受体阻滞剂多沙唑嗪（每日0.5至1.0 mg）治疗。在多沙唑嗪治疗前及治疗4周后检查尿流率和排尿后残余尿量。在16名男孩中的12名停用多沙唑嗪2周后，进行了影像尿动力学检查和膀胱镜检查。尿流改善被随意定义为Qmax增加≥2.5 mL/s。尿失禁完全改善定义为改善>90%，部分改善定义为尿失禁发作次数减少50%至90%。成功治疗定义为尿流改善以及尿失禁部分或完全改善。每次就诊时监测血压、首剂现象和不良反应。
平均用药期和随访期分别为24.5周和33.1周。10例患者（63%）尿流得到改善。Qmax从12.3±1.3 mL/s增加至16.3±4.1 mL/s（p = 0.001）。分别有7例和3例患者尿失禁完全和部分改善。每周尿床的平均次数从4.9±2.3次降至2.2±2.5次（p<0.001）。8名男孩（50%）治疗成功，包括5名原发性膀胱颈梗阻男孩中的3名、4名排尿功能障碍男孩中的3名以及4名病因未分类的神经性排尿功能障碍男孩中的2名。未出现明显不良反应。收缩压和舒张压的下降可忽略不计。
α1受体阻滞剂治疗低尿流率和尿失禁男孩有效。
