Abstract
PurposeMirabegron is a recent addition to the management options of overactive bladder (OAB) in children. The purpose of this study was to ascertain the role of Mirabegron in the treatment algorithm of therapy-resistant OAB especially after botulinum toxin.MethodsCase notes of all children receiving Mirabegron between July 2017 and February 2020 were reviewed.ResultsForty one children (21 females, 20 males), mean age 12.6 [8–17] years old, commenced Mirabegron: 35 idiopathic OAB, 6 neuropathic OAB. The mean duration of treatment was 20.7 [3–45] months. In total 24 (59%) had Mirabegron after partial/no response to anticholinergics, and 17 (41%) patients had Mirabegron subsequent to botulinum toxin A (BtA) as an exit strategy. In total 35 (85%) patients had combination therapy (Mirabegron and anticholinergics), and 6 (15%) patients had Mirabegron only. Fourteen (34%) had complete response, 17 (41%) had partial response, and 10 (24%) had no response. Side effects were reported in 7 (17%) patients with discontinuation necessitated in 3.ConclusionMirabegron when used alone or in combination with anticholinergics resulted in complete/partial response in 76% of anticholinergic therapy-resistant OAB. In addition to being an important step in treatment escalation after no/partial response to anticholinergics, it has a crucial role in the exit strategy for recurring symptoms after BtA wears off.
Highlights
Idiopathic overactive bladder (OAB) is a common lower urinary tract dysfunction (LUTD) in children and is characterized by the presence of urinary urgency accompanied with daytime urinary wetting and frequency (1)
Mirabegron was used in combination with anticholinergics in 35 (85%), 33 patients were on 10 mg solifenacin, and 2 were on 15 mg oxybutynin
A systematic review and meta-analysis conducted by Kelleher et al (10) demonstrated that the outcome of Mirabegron use in adults with OAB was better than that of placebo at reducing LUTD symptoms and as effective as most antimuscarinic therapy with fewer anticholinergic side effects as dry mouth, constipation, and urinary retention
Summary
Idiopathic overactive bladder (OAB) is a common lower urinary tract dysfunction (LUTD) in children and is characterized by the presence of urinary urgency accompanied with daytime urinary wetting and frequency (1). It may be associated with nocturia and/or nocturnal enuresis. OAB symptoms may be associated with neuropathic bladder. The overall prevalence of idiopathic OAB (IOAB) reported in children is between 5–17 % (2–4). The sequelae of uncontrolled symptoms of IOAB can have a negative impact on the children’s emotional and behavioral well-being leading to social isolation, depression, and anxiety (6)
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