Vesicoureteral Reflux and Primary Bladder Neck Dysfunction in Children: Urodynamic Evaluation

Pediatric Urology

Vesicoureteral Reflux and Primary Bladder Neck Dysfunction in Children: Urodynamic Evaluation and Randomized, Double-Blind, Clinical Trial on Effect of α-Blocker Therapy

Abdol-Mohammad Kajbafzadeh, , NimaBaradaran, ZhinaSadeghi, Ali Tourchi, ParisaSaeedi, Abbas Madani, NeamatollahAtaei,Ali Mohammad TaghavinejadM. JavadMohsseni

doi:10.1016/j.juro.2010.06.132

Editorial Comment
The Journal of Urology, Volume 184, Issue 5, November 2010, Page 2133

Purpose

Primary bladder neck dysfunction has been under diagnosed as a treatable cause of vesicoureteral reflux. We evaluated the effect of prazosin administration on vesicoureteral reflux resolution and urodynamic parameters in children with idiopathic primary reflux and primary bladder neck dysfunction.

Materials and Methods

A total of 62 children (mean ± SD age 7.9 ± 2.4 years) with documented vesicoureteral reflux and urodynamics proved primary bladder neck dysfunction were randomized to receive either 0.025 mg/kg α-blocker (prazosin, 40 patients) or placebo (22) nightly for 1 week with a subsequent increase to 2 divided doses. Patients were followed for 12 months with clinical evaluation and uroflowmetry performed every 2 months, and each patient underwent complete urodynamic study at 6-month intervals.

Results

In the placebo group no uroflowmetry or urodynamic parameter changed significantly at 1-year followup. A 60% decrease in reflux grade was observed in the treatment group compared to 17% in the placebo group. Mean maximal detrusor pressure, post-void residual and opening time were significantly decreased in both followup sessions in the prazosin group (p <0.05). Average flow rate improved from 4.30 to 12.80 ml per second at 6 months and to 13.10 ml per second at 12 months (both p <0.05).

Conclusions

Special attention should be given to secondary causes of vesicoureteral reflux (such as primary bladder neck dysfunction, an underdiagnosed entity in children), since conventional treatment will most likely fail if these conditions are not addressed promptly. In this study prazosin was effective therapy for children with vesicoureteral reflux and primary bladder neck dysfunction.

Key Words

adrenergic alpha-antagonists;
urinary bladder neck obstruction;
urodynamics;
vesico-ureteral reflux;
child

Abbreviations and Acronyms

EMG, electromyogram;
MMDP, mean maximal detrusor pressure;
PBND, primary bladder neck dysfunction;
PVR, post-void residual;
Qave, average flow rate;
Qmax, maximum flow rate;
UDS, urodynamic study;
UTI, urinary tract infection;
VCUG, voiding cystourethrography;
VUR, vesicoureteral reflux

Study received local ethics committee approval.

No conflict of interest exists in relation to the submitted manuscript and there was no source of extra-institutional commercial funding or funding received from National Institutes of Health (NIH), Wellcome Trust, Howard Hughes Medical Institute (HHMI) and others.

Correspondence: No. 32, 2nd Floor, 7th St., Saadat-Abad, Ave., Tehran 1998714616, Iran (IRI) (telephone: 98-21-2208-9946; FAX: 98-21-2206-9451)