Treatment with Phenoxybenzamine of Upper Urinary Tract Complications Caused by Intravesical Obstruction

Abstract

Five children in whom reflux and progressive hydronephrosis persisted despite multiple surgical attempts or repair are described. In all cases cystomanometry displayed a marked elevation of the bladder outlet resistance combined with high intravesical pressure values. Therapy with phenoxybenzamine, an alpha-adrenergic blocker, was successful in all cases, restoring a free urine passage of the upper urinary tract and unimpaired voiding preventing urinary diversion which has been considered in some of these children. Although there were no signs of bladder neuropathy, a hyperfunction of the sympathetic innervation as acause for bladder complications is discussed.

Clinical and urodynamic assessment of alpha-adrenolytic therapy in patients with neurogenic bladder function

“…These rather disappointing results are partly compensated by the fact that in four among eleven patients with a massive vesico-renal reflux and marked ureteral dilation (known to exist since 3 to 9 months prior to phenoxybenzamine treatment), this reflux disappeared during alpha-adrenolytic treatment. Similar findings have been reported by Stockamp (1975). that significant improvement of micturition may be observed in the young patients, particularly in teenagers.…”

The use and rationale of selective alpha blockade in children with non-neurogenic neurogenic bladder dysfunction

“…In children without neurological abnormalities, Stockamp was the first in 1975 to report the successful use of phenoxybenzamin in the situation of upper tract complications due to functional infravesical obstruction (5). Upper urinary tract dilatation improved in 3 out of 5 children.…”

“…All the components must be included in the diagnostic and treatment approach. Stockamp, in 1975, first described the use of a non-selective α-blocker in non-neurogenic bladder outlet dysfunction (5). In 1992 the use of the non-selective α-blocker phenoxybenzamine was reported in combination with urinary diversion in the Hinman syndrome as a partial success (6).…”

The Importance of Adrenergic Receptors in Disorders of Micturition

“…An example of this in a young doc tor is illustrated by the urinary flow recordings in figure 1. The treatment of a similar condition in 5 children by means of a-adrenergic blockade with phenoxybenzamine, has been reported by Stoc- (48). Although such drug treatment does not give a permanent cure, as can be afforded by an operation, it has the distinct advantage in the young patient that although it also usually causes retrograde ejaculation, this can be remedied as and when desired by withdrawal of the drug for a pe riod of time.…”