Is Doxazosin Really Beneficial in Children with Voiding Dysfunction and Significant Residuals?

Abstract

PURPOSE Alpha adrenergic blockade using medications such as doxazosin, prazosin and terazosin have been recognized to be successful in select children with voiding dysfunction and incomplete bladder emptying. We report our prospective experience of the use of doxazosin in the management of voiding dysfunction and incomplete voiding of non-neuropathic origin. MATERIAL AND METHODS Data on 19 children with voiding dysfunction, diurnal enuresis and significant residuals was collected prospectively and analysed. All children had a non-invasive urodynamic assessment including a detailed history, examination, frequency volume chart completion and uroflowmetry. The expected bladder capacity (EBC) was calculated using the formula (age in yrs. + 2) x 30 (ml) and a residual volume of greater than 10% was considered significant. Doxazosin was prescribed in a dose of 500micrograms – 2 g/day depending on side effects and response. The criteria of a successful outcome were complete resolution of symptoms and improved uroflow parameters where repeated. RESULTS Of the 19 children prescribed Doxazosin 13 showed symptomatic improvement and improvement in residual volumes of which 4 were completely dry and 9 showed improvement in voiding dysfunction and incomplete voiding. One child discontinued doxazosin due to headaches. Six had no improvement in symptoms or residual volumes. CONCLUSIONS Doxazosin resulted in complete resolution of symptoms in only 4/19(20%) of children while 33% had no improvement. Parents should be informed about the realistic prognosis of this treatment option as in this study the ‘success’ rate was much lower than previously published.