[Voiding difficulties in a child attributed to the use of ipratropium and salbutamol].

A 5-year-old child was referred to our clinic because of voiding difficulties. She had been continent for 2.5 years. She had a hesitation of the urinary flow and voided with variable residual volumes. She had been using ipratropium and salbutamol regularly for her asthma. The voiding difficulties disappeared when the inhalation medication was stopped. During provocation with both medications this adverse effect was successively confirmed. The airway complaints were adequately controlled with inhaled steroids and she manifested functional voiding. Voiding difficulties as an adverse effect of ipratropium and salbutamol have not yet been described in children. At the Netherlands Pharmacovigilance Centre Lareb a few cases in children have been reported. Interaction with the sympathetic and parasympathetic activity of the bladder and pelvic floor muscles is a possible explanation for the voiding difficulties. In the assessment of voiding problems one needs to question the patient on the use of asthma medication.