Mirabegron Versus Anticholinergics for Persistent Lower Urinary Tract Symptoms in Male Adults After Childhood Primary Nocturnal Enuresis: A Retrospective Comparative Cohort Study

Introduction Persistent lower urinary tract symptoms (LUTS) in young adults following childhood primary nocturnal enuresis (PNE) refractory to desmopressin represent an undercharacterized condition at the pediatric-adult care interface. No prior study has compared pharmacotherapy options in this specific population. Methods We performed a retrospective, single-center, hypothesis-generating comparative cohort study at a tertiary urology center (January 2017–September 2025). Male adults aged 18–35 years with documented childhood primary nocturnal enuresis (PNE) based on International Children's Continence Society (ICCS) criteria, desmopressin treatment failure, and persistent storage-phase lower urinary tract symptoms (LUTS) were included. Patients received mirabegron 25–50 mg daily (Group A, n=33) or anticholinergic therapy (Group B, n=32). The primary outcome was categorical treatment response (complete ≥75%, partial 50–74%, minimal 25–49%, failure <25%). Secondary outcomes included nocturia, urgency, micturition frequency, incontinence episodes, International Prostate Symptom Score (IPSS), quality of life, and adverse events. Analyses used independent t-tests, chi-square/Fisher exact tests, paired t-tests, and analysis of covariance (ANCOVA). Results Baseline characteristics were comparable between groups. Childhood nonmonosymptomatic enuresis (NMSE) phenotype was prevalent in 86.2% of patients, with reduced functional bladder capacity documented in 86.2%. Mirabegron achieved higher overall clinical benefit (≥50% improvement) than anticholinergics (78.8% vs. 56.3%, p=0.042) and higher complete response rates (24.2% vs. 6.3%, p=0.044). Symptom reductions consistently favored mirabegron: nocturia 51% vs. 38% (p=0.031), urgency 48% vs. 36% (p=0.024), micturition frequency 37% vs. 26% (p=0.018), and quality of life improvement 58% vs. 38% (p=0.009). Safety profiles were comparable with no serious adverse events and similar treatment persistence (90.9% vs. 87.5%, p=0.642). Conclusion Pending prospective confirmation, mirabegron provides superior efficacy with comparable safety versus anticholinergic therapy in male adults with persistent LUTS after desmopressin-refractory childhood PNE, supporting β3-adrenergic agonist therapy as a promising option for this underserved transitional population.