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 (LUTSs) 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 PNE based on International Children's Continence Society (ICCS) criteria, desmopressin treatment failure, and persistent storage-phase LUTSs 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.

RESULTS

Baseline characteristics were comparable between groups. Childhood nonmonosymptomatic enuresis 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.