Postablation and α-1 blocker therapy in children with congenital obstructing posterior urethral membrane

Abstract

Background: Congenital obstructing posterior urethral membrane (COPUM) or posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in boys. Approximately one-third of boys with PUV develop end-stage renal disease. Various prognostic factors have been recognized which determines the long-term outcome of these cases. Materials and Methods: This was a retrospective case–control analysis of data from January 1998 to May 2014. All patients of COPUM with radiological evidence of bladder neck hypertrophy with follow-up of 7 years were included in the study. Patients with urethral strictures, neurogenic bladder, and incomplete records were excluded. Group I (n = 57) received selective α-1 blocker (prazosin), after valve ablation. Group II (n = 36) who had not received the α-1 blocker was treated as a control group. Investigations include renal function test, ultrasonography, micturating cystourethrography renal dynamic scan, and glomerular filtration rate. Statistical analysis was done using the paired t-test, multiple serial analyses using ANOVA. P <0.05 was considered as significant. Results: A total of 113 patients of COPUM were treated from January 1998 to May 2014. Out of these 113, 93 patients (82.3%) were included in the study. Fifty-seven (61.2%) received α-1 blocker, while 36 patients (38.8%) acted as control. Significant decrease in bladder neck hypertrophy noted in Group I as compared to Group II (P<0.001). Conclusion: Uses of alpha-1 blocker hastens the recovery in terms of clinical improvement, resolution of bladder neck hypertrophy, and improved peak urine flow rate.

Keywords

• alpha-1 blocker
• anticholinergic
• congenital obstructing posterior urethral membrane
• posterior urethral valve