The use and rationale of selective alpha blockade in children with non-neurogenic neurogenic bladder dysfunction

Abstract

Introduction: We present here a long-term observation of 2 children with a rare syndrome with a non-neurogenic neurogenic bladder dysfunction (Hinman's syndrome), and we investigated the safety and efficacy of long-term use of terazosine in association with prophylactic antibiotics, timed voiding and a bowel regimen.Materials and Methods: Two children, 7 years-old (22 kg) and 11 years-old (36 kg) presented in 1997 to our pediatric urology clinic with symptoms of urgency, frequency, urge incontinence and nocturnal enuresis. Both children were placed in a regimen of terazosine (starting with 0.5 mg increasing until 2 mg).Results: There were no significant side effects throughout the entire treatment. The first 7-year old boy however developed some dizziness when the dose of terazosine was increased to 2 mg (after 4 weeks of administrating 1 mg), and this disappeared immediately when the dosage was reduced back to 1 mg daily. The urgency symptoms improved in both boys after 3 weeks of 1 mg terazosine. The secondary enuresis in the 11 year-old boy resolved after 2 months of 2 mg terazosine.Conclusion: It is possible to say that the alpha-blocker medication, terazosine can be administered safely to children with a non-neurogenic bladder dysfunction, also known as the Hinman's syndrome. These results have shown that dysfunctional voiding, postvoiding residual and upper tract involvement can disappear over time when long term terazosine is given in combination with timed voiding, prophylactic antibiotic therapy and treatment of the associated constipation. Our observations also suggest a permanent effect after discontinuing the medication.

An Evaluation of the Efficacy of Selective Alpha-Blockers in the Treatment of Children with Neurogenic Bladder Dysfunction—Preliminary Findings

“…This is similar to reports from other studies showing a low rate of drug related adverse events [ 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…Other studies have shown variable degrees of efficacy when using selective α-blockers in children with neurogenic and non-neurogenic bladder dysfunction [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

“…The drug was administrated “ off-label , ” according to data from other studies. The treatment was started with a dose of 0.03 mg/kg doxazosin [ 11 , 13 , 14 , 15 ].…”

Pharmacotherapy for Pediatric Neurogenic Bladder

“…In other studies, the initial dose of doxazosin in children was 0.5–2.0 mg once daily [ 145 – 149 , 156 , 157 ], or 0.03 mg/kg bodyweight/day [ 154 , 158 ]. For terazosin, a starting dose of 0.5 mg increasing to 2 mg was proposed [ 143 , 159 ]. In the study by VanderBrink et al, in children with a mean age of 8.9 years, an initial dose of tamsulosin 0.2 mg was given once a day, increasing to 0.4 mg.…”

Dysfunctional Voiding of Non-Neurogenic Neurogenic Bladder: A Urological Disorder Associated with Down Syndrome

“…The intellectual Impairment of patients with DS may cause some difficulties in conducting the treatment. Anti-cholinergics and alpha blocker therapy either alone or in combination may be useful in the treatment of NNB (Krane & Olsson, 1973;Paul et al, 1999;Bogaert et al, 2004) since significant improvement in emptying was shown in neurogenic cases treated with non selective alpha blocker (Krane & Olsson, 1973). If there is no response to conservative treatment, intermittent catheterization may be required.…”