Comparison of the Role of Anticholinergics and α-1 Adrenergic Blockers in Bladder Management in Posterior Urethral Valves: A Pilot Randomized Control Trial.

Introduction: Posterior urethral valve (PUV) is a major cause of congenital bladder dysfunction, often persisting despite treatment. Emerging therapies, including anticholinergics and α-1 blockers, offer potential but lack clear guidelines. This study evaluates their effectiveness in improving bladder function after valve fulguration.

Methods: Twenty posterior urethral valve patients, aged ≥3 years, were randomized into Anticholinergic (group A, n=11) and α-1 adrenergic blocker (group B, n=9) groups post-fulguration. Follow-up included clinical, radiological, and urodynamic assessments six months post-treatment initiation.

Results: In group A, the mean maximum detrusor pressure (Pdet) decreased from 30.17 to 23.45 cm H2O (p= 0.033). Two patients normalized from high detrusor pressure (>40 cm H2O). In group B, one patient retained high detrusor pressure post-treatment. Group B improved in Q avg and Q max, with all patients having initially low Q avg (<10 ml/sec). Two group B patients showed improved average flow rates post-treatment (p=0.016); three in group A showed improvement, but were not statistically significant (p=0.197). Q max/flow time ratio was abnormal in all group B patients pre-treatment. Two of the nine improved post-treatment, while only one in group A did.

Conclusions: Anticholinergic medications positively impact cystometric parameters and are effective for detrusor instability and low compliance bladder. α-adrenergic blockers influence uroflow parameters and can help treat bladder outflow obstruction. Consideration for a larger study with extended follow-up is warranted.