Low dose, targeted alpha blockers for refractory bladder dysfunction in children – a single centre experience

Abstract

In children with refractory bladder dysfunction, the use of alpha blockers is being explored; although it remains off-label in Australia. We report subjective and objective outcomes of low dose targeted alpha blocker therapy in refractory bladder dysfunction. A retrospective chart review at John Hunter Children’s Hospital between March 2015 and March 2019 was performed. Children with high post-void residuals (PVR) or frequency-urgency symptoms, who had failed or were intolerant to standard treatments, and were given additional alpha blocker therapy were included in this study. Data collected included; patient characteristics, medication used with its dose and duration, side effects, subjective outcomes in the form of symptomatic response and objective outcomes measured by PVR and uroflowmetry. Fifteen patients (male=13, median age=8 years) were trialled on alpha blockers, with a median follow-up of 12 months. Alpha blockers were commenced due to ongoing high PVR (n=11) or overactive bladder syndromes (n=4) (Table 1). Alpha blockers used included: Tamsulosin (n=6), Terazosin (n=7) and Prazosin (n=2). Partial resolution of symptoms was achieved in 60% (9/15), and complete resolution in 33% (5/15) of patients. In the high PVR cohort, mean PVR decreased from 100mls to 23.1mls post-alpha blocker use. Severe nausea was noted in one patient on Terazosin, necessitating discontinuation.Table 1Symptomatic response to alpha blockers for different bladder syndromes based on ICCS definitionsIndication for Alpha blockersComplete responsePartial responseNo responseValve-bladder syndrome (high PVR)21Dysfunctional voiding (high PVR)13Bladder neck dysfunction (high PVR)1Underactive detrusor (high PVR)2Voiding postponement (high PVR)1Overactive bladder syndrome121Total:591 Open table in a new tab Low dose alpha blocker therapy may provide symptomatic improvement in children with refractory bladder symptoms. The results appear less encouraging in children with overactive bladder syndrome.