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Gabapentin: a novel drug as add-on therapy in cases of refractory overactive bladder in children
M S Ansari1, Aruna Bharti, Raj Kumar
1Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, U.P., India. ansarimsa@hotmail.com
Insights
Gabapentin showed moderate effectiveness as an add-on therapy for children with overactive bladder (OAB) resistant to standard treatments. The drug was generally well-tolerated, offering symptom relief for over half of the participants.
Area of Science:
- Pediatric Urology
- Pharmacology
- Nephrology
Background:
- Overactive bladder (OAB) in children often presents challenges with conventional anticholinergic therapies.
- Refractory OAB necessitates exploring alternative or add-on treatment strategies.
Purpose of the Study:
- To evaluate the efficacy of gabapentin as an adjunctive treatment for pediatric overactive bladder (OAB) unresponsive to anticholinergics.
- To assess urodynamic parameters and continence outcomes in children receiving gabapentin for refractory OAB.
Main Methods:
- Prospective study of children with refractory OAB on anticholinergics for at least 6 months.
- Gabapentin administered as add-on therapy, with follow-up including bladder diaries and urodynamic studies at 3 months.
- Data analyzed from 30 patients, with one discontinued due to adverse effects.
Main Results:
- Continence improved in 53.3% of patients; voiding volume increased significantly (175 to 320 ml).
- Urodynamic findings showed improved maximum cystometric bladder capacity (210 to 360 ml) and reduced detrusor contractions (75 to 25 cmH2O).
- 14 patients (46.7%) did not respond, particularly those with low baseline bladder capacity or high detrusor contractions.
Conclusions:
- Gabapentin offers moderate therapeutic benefits for pediatric overactive bladder (OAB) refractory to standard anticholinergic medications.
- The add-on use of gabapentin is generally well-tolerated in this pediatric population, with a favorable side effect profile.
- Predictive factors for non-response include low baseline bladder capacity and high detrusor contractility.
Objective:
To determine the effectiveness of gabapentin as an add-on therapy in children presenting with overactive bladder (OAB) not responding to conventional anticholinergics.
Materials And Methods:
Children with refractory OAB were included prospectively from March 2009 to February 2010. The inclusion criterion was persistence of symptoms while on conventional anticholinergics for 6 months. Gabapentin was prescribed as an add-on therapy. The patients were followed 4 weekly with bladder diary and urodynamic study was repeated at 3 months.
Results:
There were 31 children, 26 of neurogenic OAB and 5 of non-neurogenic origin. Mean ± SD age was 8.5 ± 5.3 years. Data were analyzed in 30 patients as treatment was terminated in 1 due to adverse effects. Continence improved in 16 (53.3%) patients. Voiding volume improved from 175 ± 90 to 320 ± 110 ml (p<0.03). Objective assessment of OAB symptom relief showed marked improvement (p<0.05). Mean maximum cystometric bladder capacity improved from 210 ± 94 to 360 ± 110 ml (p<0.02). The maximal detrusor contraction decreased from 75 ± 35 to 25 ± 15 cmH(2)O (p<0.02). Fourteen patients (46.7%) failed to respond to gabapentin therapy. These patients had baseline maximum cystometric bladder capacity <60% for age and maximum detrusor contractions >50 cm of water (p<0.03).
Conclusions:
Gabapentin gives moderate results in children with OAB refractory to conventional anticholinergics. In general, the drug is well tolerated with fewer adverse effects.
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