1618 ALPHA ADRENERGIC BLOCKADE IN NEONATES WITH POSTERIOR URETHRAL VALVES

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia II1 Apr 20121618 ALPHA ADRENERGIC BLOCKADE IN NEONATES WITH POSTERIOR URETHRAL VALVES Jason Skenazy and Mark Horowitz Jason SkenazyJason Skenazy Brooklyn, NY More articles by this author and Mark HorowitzMark Horowitz Brooklyn, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1413AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Secondary bladder neck obstruction has been described in patients with congenital obstruction of the urethra from posterior urethral valves (PUV). Despite aggressive management with valve ablation and anti-cholinergic medications, there is continued upper tract deterioration leading to renal failure in some patients with PUV. It is thought that elevated filling and voiding pressures with progressive loss of compliance are the primary causes. Tamsuolsin is an alpha-1 adrenoceptor antagonist with preferential activity in the alpha-1a receptors of the prostate, prostatic urethra, and bladder neck. Several centers have reported their experience with the use of other alpha blockers in children. We report our experience with the use of Tamsulosin in newborns with PUV. The safety and efficacy of alpha-blocker in newborns justifies its use in this select group of patients. METHODS Nineteen patients were treated between 2005 and 2010. Tamsulosin and anti-cholinergic therapy were started (at mean age of 6 days) in all patients prior to transurethral resection of the valves. Tamsulosin was started at a dose 0f 0.1 mg/day, compounded by local pharmacies. Patients were followed with serial ultrasounds, serum creatinines, and when indicated, videourodynamics. RESULTS Of the 19 patients, none were lost to follow-up. The medication was well-tolerated, there were no difficulties in administration by the family, and no patients had Tamsulosin discontinued. The serum creatinine decreased in all patients, and the hydronephrosis improved in all but two patients. Another two patients who were initially treated with bilateral nephrostomy tubes for significant hydro-ureteronephrosis, as they were two young for cystoscopy, had complete resolution on Tamsulosin. The post-Tamsulosin nephrostograms showed complete resolution of the secondary ureterovesical obstruction that is often seen with valve patients. After starting Tamsulosin, normal filling and voiding pressures were seen in almost half the initial studies and continuing improvement was seen in the rest. CONCLUSIONS Tamsulosin is safe, well-tolerated, and efficacious in newborn patients with PUV. There were no side effects related to it's use. It should be considered as part of the regimen in the treatment of patients with PUV. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e654 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason Skenazy Brooklyn, NY More articles by this author Mark Horowitz Brooklyn, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...