title: Doxazosin versus tizanidine for treatment of dysfunctional voiding in children: a prospective randomized open-labeled trial.
abstract: OBJECTIVE
  To examine the efficacy and tolerability of tizanidine for the treatment of dysfunctional voiding in children compared with those of doxazosin.
  
  
  METHODS
  A total of 40 children with dysfunctional voiding were enrolled in a prospective, randomized, 2-parallel group, flexible-dose study. The evaluations were performed in accordance with the International Children's Continence Society guidelines. The children were followed up after 1 week and then monthly for 6 months for the clinical, urine culture, and urodynamic parameters. The degree of improvement was assessed using a satisfaction scale that ranged from 0 (no improvement at all) to 10 (total improvement).
  
  
  RESULTS
  A total of 40 patients with a mean±SD age of 7±2.6 years were enrolled. The clinical and urodynamic parameters were comparable between both groups. At the last follow-up visit, both groups had had similar improvement in the severity of symptoms, satisfaction scale, and noninvasive flowmetry parameters. In the doxazosin group, urge episodes was the only symptom that showed a significant reduction compared with the baseline values (P=.028). However, the incidence of nocturnal enuresis, urgency attacks, and daytime incontinence were significantly reduced compared with baseline in the tizanidine group (P=.003, P=.008, and P=.017, respectively). Adverse effects were recorded in 6 patients (15%). Epigasteric pain was reported in 2 children (10%) who received doxazosin. In the tizanidine group, a loss of appetite was noted in 2 children (10%), epigastric pain in 1 (5%), and headache in 1 (5%).
  
  
  CONCLUSIONS
  Tizanidine could be a safe and effective treatment of children with dysfunctional voiding due to pelvic floor/skeletal sphincter dysfunction. More placebo-controlled trails with larger sample sizes are needed.
authors.affiliation: Voiding Dysfunction and Urodynamic Section, Urology and Nephrology Center, Mansoura University, and Children's Hospital, Mansoura, Egypt. a_s_elhefnawy@yahoo.com
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: El-Hefnawy
authors.forename: Tamer
authors.initials: T
authors.lastname: Helmy
authors.forename: Mohamed M
authors.initials: MM
authors.lastname: El-Assmy
authors.forename: Osama
authors.initials: O
authors.lastname: Sarhan
authors.forename: Ashraf T
authors.initials: AT
authors.lastname: Hafez
authors.forename: Mohammed
authors.initials: M
authors.lastname: Dawaba
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058647:Adrenergic alpha-2 Receptor Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000855:Anorexia / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D017292:Doxazosin / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000188:drug therapy; D010146:Pain / Q000139:chemically induced; D014549:Urinary Incontinence / Q000188:drug therapy; D014555:Urination Disorders / Q000188:drug therapy*
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D058647:Adrenergic alpha-2 Receptor Agonists; C023754:tizanidine; D003000:Clonidine; D017292:Doxazosin