Side effects of medical therapy for non-neurogenic lower urinary tract symptoms in children: a UK-based single centre retrospective case-note review

OBJECTIVES: We aimed to study time to, and reason for, discontinuation of medication to manage daytime lower urinary tract symptoms (LUTS) in children, the impact of side effects (SE) on tolerance and the time-burden of failed treatment. DESIGN: UK-based single centre retrospective case-note review. SETTING: Tertiary level nurse-led urology clinic. PATIENTS: 200 children prescribed anti-cholinergics and/or mirabegron to manage daytime LUTS due to overactive bladder between 2016 and 2021. MAIN OUTCOME MEASURES: Age and sex, medications prescribed, time to and reason for discontinuation of medications and SE reported. RESULTS: 200 children (71% female), median age 11 (IQR 9-13) years prescribed 371 medications were included. 106 were prescribed a second medication, 50 a third, 17 a fourth medication (2 dual-therapy regimens). 147 received oxybutynin, 94 (64%) discontinued it for reasons other than treatment success after 337 (94-456) days, 47 (32%) due to SE, a significant number due to mood changes (15, 32%, p<0.05). For oxybutynin, increased age and presence of SE resulted in shorter time to discontinuation (p=0.047). 100 received tolterodine, 63 (63%) discontinued it after 312 (147-553) days, 25 (25%) due to SE, 11 (44%) for mood changes. Children prescribed solifenacin (86) and mirabegron (38) had significantly fewer SE compared with oxybutynin (solifenacin p=0.020, mirabegron p=0.025). CONCLUSIONS: This study shows that oxybutynin and tolterodine were frequently discontinued due to SE, many of which are classified as 'psychiatric' or 'nervous system' disorders. Solifenacin and mirabegron were better tolerated: future research should investigate optimal medical therapy for LUTS in children.