Urodynamic effectiveness of a beta-3 adrenoreceptor agonist (vibegron) for a pediatric patient with anticholinergic-resistant neurogenic detrusor overactivity: a case report

Abstract

Background Myelomeningocele, which causes a neurogenic bladder, is usually treated with anticholinergics in children with neurogenic detrusor overactivity (NDO); however, anticholinergics cause side effects such as dry mouth, constipation, attention deficit, and inadequate reduction in detrusor leak point pressure. Vibegron, a novel selective beta-3 adrenoreceptor agonist, is a well-established alternative to anticholinergics in adults with an overactive bladder. It remains unknown whether this agent can be used for pediatric patients. We report the case of a girl with anticholinergic-resistant NDO due to tethered cord syndrome after myelomeningocele repair, who was treated with vibegron. Case presentation A 4-year-old Filipino girl had increased frequency of daytime urinary incontinence and foul-smelling urine since the age of 3. Clinical examination revealed constipation, and urinalysis revealed bacteriuria. Voiding cystourethrography revealed an enlarged and trabeculated bladder without vesicoureteral reflux. On the urodynamic study (UDS), she was found to have detrusor overactivity (DO) and low bladder compliance. She could not void and was diagnosed with overflow incontinence. Clean intermittent catheterization (CIC) and orally administered propiverine (0.8 mg/kg/day) were initiated, and urinary incontinence was resolved. She underwent a UDS annually; the UDS at 6 years of age still revealed DO and low bladder compliance in spite of receiving propiverine. The treatment was switched from propiverine to vibegron (1.4 mg/kg/day). On the UDS after a 5-week treatment schedule of vibegron, the DO disappeared and the bladder compliance improved. CIC and orally administered vibegron have been continued for 7 months so far, and she has had no urinary tract infection with no drug-related adverse events. Conclusions Vibegron was effective and well tolerated in the treatment of a pediatric patient with NDO. Vibegron improved the urodynamic parameters for anticholinergic-resistant neurogenic bladder. This agent can be a beneficial and preferable alternative therapeutic agent to anticholinergics in patients with anticholinergic-resistant NDO.

Vibegron shows high efficacy in pediatric patients with refractory daytime urinary incontinence

“…No prior reports have examined vibegron, even though it is reportedly more effective against lower urinary tract symptoms than mirabegron in adult patients 4 . Sparse published reports exist nowadays on vibegron and pediatric OAB 10,11 . The current study demonstated vibegron was highly effective in treating pediatric DUI.…”

“…4 Sparse published reports exist nowadays on vibegron and pediatric OAB. 10,11 The current study demonstated vibegron was highly effective in treating pediatric DUI. Several features of pediatric micturition differ from those in adults.…”

Video‐urodynamic effects of vibegron, a new selective β3‐adrenoceptor agonist, on antimuscarinic‐resistant neurogenic bladder dysfunction in patients with spina bifida

“…23,24 The efficacy of vibegron on neurogenic bladder dysfunction has been investigated in a case report. 24 In the present study, MCC and BC were significantly improved, and VUR diminished after switching from antimuscarinic agents to vibegron. Attention is necessary when measuring the MCC, because it varies depending on the DLPP.…”

“…Therefore, use of vibegron might be easy. Recently, a few reports have shown the efficacy and safety of vibegron for the treatment of OAB in adults, 20–22 and only a few studies in children have been reported 23,24 . The efficacy of vibegron on neurogenic bladder dysfunction has been investigated in a case report 24 …”

“…Recently, a few reports have shown the efficacy and safety of vibegron for the treatment of OAB in adults, [20][21][22] and only a few studies in children have been reported. 23,24 The efficacy of vibegron on neurogenic bladder dysfunction has been investigated in a case report. 24 In the present study, MCC and BC were significantly improved, and VUR diminished after switching from antimuscarinic agents to vibegron.…”