Updates of Overactive Bladder in Pediatrics

Area of Science:

• Pediatric Urology
• Neuroscience
• Pharmacology

Background:

• Overactive bladder (OAB) affects 5%-12% of children aged 5-10, characterized by urinary urgency, frequency, and incontinence.
• Neurological pathways involving the pontine micturition center, periaqueductal gray matter, and prefrontal cortex are crucial for micturition control.
• Comorbidities like anxiety, depression, and attention deficit disorder are frequently observed in pediatric OAB cases, with their treatment positively impacting OAB symptoms.

Purpose of the Study:

• To review the pathophysiology and associated conditions of pediatric overactive bladder.
• To present updated treatment strategies for overactive bladder in children.
• To propose a sequential, step-by-step treatment approach for managing pediatric OAB.

Main Methods:

• Literature review focusing on OAB pathophysiology, comorbidities, and treatment advancements.
• Analysis of current pharmacologic and non-pharmacologic treatment options.
• Synthesis of evidence to propose a tiered treatment strategy.

Main Results:

• OAB pathophysiology involves complex neurological interactions affecting bladder control.
• Neuropsychiatric comorbidities significantly influence OAB presentation and treatment outcomes.
• Recent advancements include beta-3 agonists and alpha-blockers as alternatives to anticholinergics, alongside electrical stimulation and botulinum toxin for refractory cases.

Conclusions:

• A comprehensive approach to pediatric OAB requires addressing both urological and neuropsychiatric aspects.
• Treatment should follow a stepwise progression: behavioral therapy, followed by medical interventions, and finally invasive treatments if necessary.
• Emerging pharmacologic and procedural options offer improved management for refractory pediatric overactive bladder.