Abstract General Information

Title

MIRABEGRON TREATMENT OUTCOMES IN TREATMENT RESISTANT FREQUENT NON MONOSYMPTOMATIC ENURESIS (NMNE)

Introduction and objective

The management of NMNE is step wise and includes management of constipation, treating lower urinary tract dysfunction, and Desmopressin + alarm; anticholinergics and Imipramine.
Mirabegron is a novel b-3 agonist licensed in adult population for overactive bladder, promoting smooth muscle relaxation and has shown promise in treating enuresis in adults.
Our objective was to review the symptomatic outcome > 24 months after starting Mirabegron in a Paediatric population with significant NMNE who had failed previous treatment modalities.

Method

Retrospective, single center review. All patients had previously failed treatment with an anticholinergic in combination with desmopressin and/or imipramine, prior to starting Mirabegron.

Results

61 patients in total (50% male) were started on Mirabegron (25-50mg daily), either alone 36%, or in combination with anticholinergic 49% and/or desmopressin 44%.
30% of Patients initially referred as monosymptomatic nocturnal enuresis despite subsequently found to have lower urinary tract dysfunction (non monosymptomatic nocturnal enuresis).
Mean age at start of treatment: 11.1 years (5-17years).
Average duration of treatment 24.44m (3-76m).
11% reported side effects (3.3% stopped): Rash 1 (stopped), Urine tract infection 1 (stopped), Constipation 1, Dizzy 1, Palpitations 1, Headache 1, Thirst 1.
6.6% were lost to follow up.
3.3% non-compliant with medication.
23% failed treatment with Mirabegron. Of those that failed, majority progressed to botox (8), imipramine/desmopressin (5), catheterization (1) or off medication (1).
60% of patients achieved nocturnal continence at final follow up. Further 5% improved <2/7 on treatment.

Conclusion

Mirabegron alone, or in combination with an anticholinergic/desmopressin, offers a well-tolerated and effective treatment for children and young people suffering from severe non-monsymptomatic nocturnal enuresis that has failed to respond to treatment. Resolution occurred in 60% of patients by last follow up in this treatment-resistant group.