Kroll Paweł, Jankowski Andrzej, Maćkowiak Jakub
Katedra Chirurgii Dzieciecej, Klinika Chirurgii, Traumatologii i Urologii Dzieciecej Akademii Medycznej im K Marcinkowskiego w Poznaniu.
Przegl Lek. 2006;63 Suppl 3:226-8.
To compare the efficiency of selective alpha1-blocker and behavioural therapy in the treatment of detrusor-sphincter discoordination in children.
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.
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).
Both treatment methods seemes to be effective in detrusor-sphincter discoordination. Selective alpha1-blockers alone are more effective than training and rehabilitation exercises.
比较选择性α1受体阻滞剂与行为疗法治疗儿童逼尿肌-括约肌失调的疗效。
前瞻性随机研究，经伦理委员会批准，60名儿童，年龄5至17岁，患有逼尿肌-括约肌失调。所有儿童均有以下病史：复发性尿路感染、排尿日记中排尿不规则（有无尿失禁）。所有儿童超声检查上尿路均正常。通过病理性尿流率曲线及超声检查残余尿量显著来诊断失调。治疗组1（n = 30）：按年龄相关剂量使用选择性α1受体阻滞剂（多沙唑嗪）治疗。组2（n = 30）：行为疗法及康复训练，记录“排尿日记”并定时排尿。所有儿童还接受了正确如厕姿势及盆底肌肉放松的指导。6周后：评估排尿模式变化：每日排尿次数、平均排尿量。进行尿流率测定并计算排尿量、平均流速、曲线形状（1 = 正常，2 = 变平、不规则，3 = 分段）、残余尿量（排尿量的10%）。进行尿液分析及尿培养。
60名儿童中有57名完成研究：组1（n = 30），组2（n = 27）。组1（α1受体阻滞剂）：排尿模式改善n = 21，尿流率参数改善n = 20。组2（康复训练）：17名患者有改善。组1（α1受体阻滞剂）6名儿童出现副作用（头痛、肌张力减退、眩晕、鼻出血），组2（康复训练）无副作用。
两种治疗方法对逼尿肌-括约肌失调似乎均有效。单独使用选择性α1受体阻滞剂比训练及康复锻炼更有效。
