Pd04-08 Mirabegron as Part of Combination Therapy for Treatment of Refractory Neurogenic Bladder in Pediatric Patients With Spina Bifida

You have accessJournal of UrologyPediatrics I (PD04)1 May 2024PD04-08 MIRABEGRON AS PART OF COMBINATION THERAPY FOR TREATMENT OF REFRACTORY NEUROGENIC BLADDER IN PEDIATRIC PATIENTS WITH SPINA BIFIDA Tyler M. Gaines, Paul Campbell, Katherine Fischer, Jason Van Batavia, Dana Weiss, Stephen Zderic, Michael Daughtery, Brian Vanderbrink, and Christopher Long Tyler M. GainesTyler M. Gaines , Paul CampbellPaul Campbell , Katherine FischerKatherine Fischer , Jason Van BataviaJason Van Batavia , Dana WeissDana Weiss , Stephen ZdericStephen Zderic , Michael DaughteryMichael Daughtery , Brian VanderbrinkBrian Vanderbrink , and Christopher LongChristopher Long View All Author Informationhttps://doi.org/10.1097/01.JU.0001008812.05762.7f.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A select number of pediatric patients with spina bifida will have progressive worsening of bladder dynamics despite adherence to antimuscarinic therapy and intermittent catheterization. Mirabegron has been shown to improve abnormal bladder wall dynamics in the neurogenic bladder (NGB ) population, but there is limited information on its efficacy as additive therapy in the treatment of refractory NGB in pediatric literature. This study assessed the utility of mirabegron as combination therapy in pediatric patients with spina bifida who have insufficient improvement of bladder dynamics on antimuscarinic monotherapy. We hypothesized that using mirabegron in combination with antimuscarinic therapy would lead to improved bladder dynamics on repeat urodynamic studies. METHODS: Patients with spina bifida and NGB under the age of 21 on combination therapy consisting of an antimuscarinic agent and mirabegron were retrospectively reviewed from two centers. All patients had persistent high-risk urodynamic features and/or urinary incontinence on a single antimuscarinic agent. Clinical characteristics and urodynamic parameters were assessed on a single antimuscarinic agent as well as combination antimuscarinic/mirabegron pharmacotherapy at follow up. RESULTS: A total of 103 patients met inclusion criteria, including 95 patients with myelomeningocele and 8 patients with lipomeningocele. Intermittent catheterization was performed in 88 patients (86%). The median age was 12 years with a mean time on dual therapy of 193 days. Poor bladder compliance (79%) was the most common indication for addition of mirabegron to antimuscarinic monotherapy, followed by small bladder capacity (11%), upper tract changes (6%) and incontinence (5%). Detrusor opening and end fill pressures were significantly lowered on combination therapy (p<0.01) compared to antimuscarinic monotherapy. Median cystometric capacity increased from 70% to 101% of expected capacity on combination therapy (p=0.08). Detrusor overactivity improved or resolved in 59% of patients with the addition of mirabegron (p=0.218). The majority of patients had significant improvement (43%) or resolution (36%) of reported urinary incontinence with the addition of mirabegron (p=0.043). CONCLUSIONS: The addition of mirabegron resulted in improvement in storage pressures and subjective incontinence in pediatric spina bifida patients not adequately managed with a single antimuscarinic agent. Download PPT Source of Funding: N/A © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e86 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Tyler M. Gaines More articles by this author Paul Campbell More articles by this author Katherine Fischer More articles by this author Jason Van Batavia More articles by this author Dana Weiss More articles by this author Stephen Zderic More articles by this author Michael Daughtery More articles by this author Brian Vanderbrink More articles by this author Christopher Long More articles by this author Expand All Advertisement PDF downloadLoading ...