I encounter patients on a daily basis who are taking medications for urinary issues. Incontinence, frequency, BPH, and frequent UTIs are common problems in geriatrics that can lead to the use of medications. Here are some of my pet peeves with these issues.
No One Ever Reassesses OAB Medications
Patients who get placed on medications to help with overactive bladder sometimes do not respond to these medications very well. I have seen numerous scenarios where patients will get started on medications like urinary anticholinergics (oxybutynin, tolterodine, etc.) or beta-agonists (mirabegron, vibegron), and three to six months after initiation they are right back where they started, complaining about urinary frequency and overactive bladder symptoms. It is critical to reassess these medications periodically to help ensure that they are at the minimum effective dose and to prove that they are actually still helping. Obtaining baseline information (i.e. how many times per day do they go to the bathroom) prior to adding one of these medications can help us remain objective. In addition, a periodic trial hold to reassess if the patient can tell the difference is reasonable to consider as well.
Anticholinergics Medications in BPH
Time and time again, I will witness patients taking over-the-counter sleep aids that are highly anticholinergic. Drugs like diphenhydramine and doxylamine can worsen symptoms of urinary retention and lead to an exacerbation of BPH symptoms. When a patient needs new BPH medications or high dosages to treat symptoms, be sure to reassess that the patient is not taking anticholinergic medications. I discuss more examples like this and the prescribing cascade at great length in my recent highly rated book Perils of Polypharmacy.
SGLT-2 Risks in Frequent UTIs
Frequent UTIs are a relatively common issue in our geriatric female population. The utilization of the SGLT-2 inhibitors for diabetes and heart failure has been on the rise. One significant concern with these agents is that they increase the amount of sugar in the urinary which can facilitate the growth of bacteria and may increase the risk of infection. In patients who are needing frequent antibiotics for UTIs, be sure to reassess if the patient is taking an SGLT-2 inhibitor.
Alpha-blocker use for conditions other than BPH has declined over time, but I still see them used occasionally. Rarely, alpha-blockers will be used for hypertension and I occasionally see prazosin used for nightmares. When a patient is on an alpha-blocker like this, be sure we don’t add another alpha-blocker for BPH symptoms to avoid using two of these agents together. I’ve seen this a handful of times in my career.
What else bugs you with urinary issues?
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