title: Ephedrine hydrochloride: novel use in the management of resistant non-neurogenic daytime urinary incontinence in children.
abstract: OBJECTIVE
  To determine whether the adrenoceptor agonist, ephedrine hydrochloride, is an effective treatment for resistant non-neurogenic daytime urinary incontinence in children.
  
  
  METHODS
  From 2000 to 2010, eighteen children with resistant non-neurogenic daytime urinary incontinence were treated with oral ephedrine hydrochloride at our institution. Sixteen were female and two were male. Median age at treatment was 12 years (range 5-15 years). Two children had spina bifida occulta. There were no other co-morbidities. Multiple anticholinergics were prescribed and dose maximized to support a bladder and bowel training programme, without achieving continence in this resistant group of children. Pre-treatment urodynamics were normal in 10, but revealed an open bladder neck in 8 patients. None showed detrusor over-activity. Oral ephedrine hydrochloride was started at 7.5 mg or 15 mg twice daily and titrated up to a maximum of 30 mg four times daily according to response.
  
  
  RESULTS
  Median follow-up was 7 years (range 6-8 years). Seventeen children (94%) reported improvement in symptoms and six (33%) achieved complete urinary continence. All patients maintained compliant bladders on post-treatment urodynamics. Seven of the 8 previously open bladder necks were closed. No patients reported any significant side effects. Patients with open bladder necks on pre-treatment urodynamics were more likely to show a full response to ephedrine (odds ratio 15; 95% CI 1.2-185.2).
  
  
  CONCLUSIONS
  Oral ephedrine hydrochloride is an effective treatment for carefully selected children with resistant non-neurogenic daytime urinary incontinence.
authors: Department of Paediatric Surgery & Urology, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK. Electronic address: neilfeatherstone@doctors.org.uk.
authors: Neil
authors: N
authors: Featherstone
authors: Joanna
authors: J
authors: Stanwell
authors: Susan
authors: S
authors: Affleck
authors: Kate
authors: K
authors: Wang
authors: Feilim
authors: F
authors: Murphy
authors: Su-Anna
authors: SA
authors: Boddy
mesh_terms: D000293:Adolescent; D018663:Adrenergic Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D053207:Diurnal Enuresis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004809:Ephedrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011859:Radiography; D016135:Spinal Dysraphism / Q000601:surgery; D014039:Toilet Training; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000187:drug effects; D001748:Urinary Bladder Neck Obstruction / Q000601:surgery; D014563:Urodynamics / Q000187:drug effects*
chemical_list: D018663:Adrenergic Agents; D004809:Ephedrine
keywords: Adrenoceptor agonist; Daytime urinary incontinence; Ephedrine hydrochloride; Open bladder neck; Paediatric