The Role of Urinary ATP in the Diagnosis, Treatment, and Follow-up of Children With Overactive Bladder.

AIM: Recent studies have highlighted the relationship between biomarkers and overactive bladder (OAB). Detrusor overactivity has been linked to increased Adenosine Triphosphate (ATP) secretion from urothelium and cholinergic nerve endings. This study aimed to evaluate urinary ATP as a diagnostic and follow-up biomarker for children with OAB, previously studied only in adults and children with neurogenic bladders.

MATERIALS AND

METHODS

Fifty-eight children with OAB and 28 healthy controls were prospectively included. Two midstream urine samples were collected from the OAB group: one pretreatment and one at the first month of anticholinergic treatment. Urine samples were centrifuged, stored at -80°C, and ATP levels were measured via ELISA. Comparisons were made between the groups and pre-/posttreatment ATP levels in the OAB group. Correlation analysis was conducted between ATP levels and lower urinary system (LUS) parameters.

RESULTS

Of the OAB group, 29 (50%) were male, with a median age of 7 years (5-15), compared to 10 years (5-16) in controls. Median urinary ATP was significantly higher in the OAB group [12.15 (2.48-170.62) ng/mg Cr] than in controls [9.92 (3.09-29.95); p = 0.04]. No significant difference was found between pre- and posttreatment ATP levels in the OAB group (p = 0.84), nor was there a correlation between ATP levels and LUS parameters.

CONCLUSION

This prospective trial is the first to document that urinary ATP levels are higher in children with OAB. Consequently, urinary ATP could serve as a diagnostic biomarker for OAB in children. Larger studies with varying symptom levels and invasive urodynamic testing are needed to further evaluate its clinical utility, particularly in monitoring treatment response.

CLINICAL TRIAL REGISTRATION: NCT06785558.