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Introducción. El síndrome de micción no coordinada se caracteriza por un cuadro de disfunción de vaciado vesical debido a la contracción activa del esfínter externo durante el vaciado. Su diagnóstico se basa en los resultados flujoméricos y electromiográficos y el tratamiento está enfocado a mejorar la relajación del esfínter durante la micción, siendo el biofeedback el tratamiento de elección. Dado que aún existen centros sin esta posibilidad, la alternativa son los alfa-bloqueantes, sin mucha literatura al respecto. Objetivo. Determinar la eficacia de los alfa-bloqueantes como tratamiento alternativo al biofeedback en ausencia de este como posibilidad terapéutica. Material y métodos. Presentamos un total de 17 casos de síndrome de Hinman que se encuentran en seguimiento en la consulta de urología pediátrica. Realizamos un estudio retrospectivo. Valoramos la edad y sintomatología al diagnóstico, la presencia de patología urológica asociada, los resultados flujométricos pre y posttratamiento, el tipo (..) (AU)

Introduction. Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flow metry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. Objective: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. Material and methods: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flow metry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. Results. There were 12 girls and 5 boys. The mean age at diagnosis (..) (AU)

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RESUMEN

INTRODUCTION: Dysfunctional voiding syndrome in children is characterized by a pattern of dysfunctional bladder emptying due to an active contraction of the external sphincter during micturition. Diagnosis is based on electromyographic and flowmetry results. The treatment is focused on relaxing the external sphincter during micturition where biofeedback is the treatment of choice. By the moment there are still centres without this possibility, alpha blockers are an alternative. OBJECTIVE: To determine the efficacy of alpha blockers as an alternative to biofeedback as a therapeutic possibility. MATERIAL AND METHODS: We included a total of 17 children with dysfunctional voiding syndrome and carried out a retrospective study. We registered age, symptoms at diagnosis, presence of associated urologic problems, flowmetry results pre and post-treatment, type of treatment used and its effectiveness comparing patients treated with alpha blockers and those who are starting to deal with biofeedback. RESULTS: There were 12 girls and 5 boys. The mean age at diagnosis was 4.9 years old, 88% of these children related enuresis, diurnal urinary incontinence and urgency, 57% of them had also urinary infections, 63% constipation, 36% had psychosocial problems. Ten patients were treated with alpha-antagonists: 6 with Tamsulosin and 4 with Doxazosin. They followed this treatment an average of 5.8 months, range between 2 and 12 months. Five patients were treated with biofeedback. All cases had an abnormal pelvic electromyography. Patients treated with alpha-blockers achieved a 70% of electromyographic improvement with a 70% of recurrence. In children treated with biofeedback we got improvement in 80% with no recurrence. After alpha blocker therapy, maximum flow rates and average flow values were better but not statistically significant, this difference was significant with biofeedback. A patient treated with Tamsulosin left treatment due to hypotension, 2 patients left Doxazosin because of dizziness. CONCLUSIONS: Alpha-blockers are effective in the treatment of dysfunctional voiding syndrome with a high percentage of recurrence. They can be an alternative to biofeedback but this one is the effective and definitive treatment.

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