Dr. Saurabh Subhash Pandya
Urology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My mother is 96 years old. Five years ago, she had many recurring UTIs caused by E.coli with positive cultures on urinalysis with burning urination and incontinence. She does not have them now. Now she has dementia and is on the tablet Mirabegron. However, she has more urinary accidents and large uncontrolled voids. She had a urinalysis, urine culture, and a blood panel test last week. Her electrolytes are under control. Her urinalysis was clear for nitrites, RBCs, and WBCs, and her urine was clear. She might not have taken a midstream sample, though, and no urine microscopy was done. I do not know if the urine culture will come back positive. If it does, I do not wish that the GP readily treats it as it will set her up for true UTIs. Or do they need to treat it as she has more confusion and large incontinence accidents?
Please give your suggestions.
Hello,
Welcome to icliniq.com.
I understand your concern.
For patients with recurrent UTIs (urinary tract infections), on prophylactic antibiotics, for any suspected UTI, we can start treatment irrespective of the reports. So that is one option. The second would be to add a low dose of anticholinergics like the tablet Darifenacin 7.5 mg once daily. This will add to the effect of the tablet Mirabegron (beta-3 adrenergic agonists).
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for the response.
Would you still add the tablet Darifenacin if she is already taking 5 to 10 mg of tablet Donepezil? Mirabegron had some benefits a while ago but not as many recently. She has sleep apnea and uses a BIPAP. Her apneas have decreased a bit this past week and so have the number of accidents from four per day to two. But it looks like she voids with no control whatsoever. Her urine culture came back as mixed growth of uncertain significance. She does not have the traditional UTIs of yesteryears. She has dementia of some sort, and it is progressing.
Please help.
Hello,
Welcome back to icliniq.com.
The tablet Donepezil (cholinesterase inhibitors) for Alzheimer's disease has some procholinergic actions that cause diarrhea and increased urinary frequency. So the tablet Darifenacin (antimuscarinics) should help as it is anticholinergic and reduces the frequency of urination. Also, it is bladder specific with minimal crossing into brain tissue, so it is safe. Also, whenever you are at home for a full day, you can try noting frequency-volume diary for 24 hours, measuring the intake of fluids versus urine output in terms of the number of episodes and volume. Volume can be measured in a urine pot or, if using diapers, by weighing diapers before and after use. This gives an approximate daytime and nighttime (sleep) urine output, and we can see if she has nighttime polyuria. If yes, medication can be given for that. Take the tablet Darifenacin 7.5 mg half the dose, to begin with. If suitable, we can increase the dose to 15 mg once daily after 15 days. (Consult a specialist doctor, talk to him or her, and start the medicine with their consent).
I hope this helps.
Take care.
Patient's Query
Hello doctor,
Thank you for your reply.
She also has heart failure and takes 1.5 mg tablet Burinex daily which drives all this. There are no accidents on the day she does not take any diuretics.
Please help.
Hello,
Welcome back to icliniq.com.
But we need to give those medications, so their side effects on urination have to be accepted by us and treated. Her dementia would worsen with time so we can expect urinary problems to worsen despite medications. Darifenacin is safe for cardiac patients.
I hope this helps.
Take care.
Patient's Query
Hello doctor,
Thank you for your reply.
Her family doctor declined the tablet Darefenacin citing that he was not familiar with taking it with the tablet Mirabegron. Would this have helped 5, 20, 50, 80 percent, etc., in holding urine? If it was a higher chance, I will ask again. She is only taking 5 mg of the tablet Donepezil instead of 10 mg. It did not hold off dementia and probably contributed to both urine and fecal incidents. She now wears an absorbent at night. I realize she is 96. She has stable CHF at the moment but much faster-advancing dementia than expected. Two weeks ago, she spoke sentences. Now it is yes or no, and I feel sad about it. I shall do my best to keep her at home till she passes. Nursing homes are a mess, and respiratory viruses are just adding more turmoil.
Please give your suggestions.
Hello,
Welcome back to icliniq.com.
You are taking great care of her. Yes, if we can add tablet Darifenacin 7.5 mg or tablet Solifenacin (antimuscarinics) 5 mg once a day, it would be good.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thank you for your advice.
Can one use the tablet Darifenacin and not tablet Mirabegron? Also, can one get used to a bladder drug and will it lose its effectiveness? Unfortunately, our family doctor has suggested not to use both. I have changed her absorbent five times. I am giving her 0.5 mg tablet Burinex during the day. Yesterday it was 0.5 plus 0.5 and she had only one incident. However, it was tough to manage.
Please share your opinion.
Hello,
Welcome back to icliniq.com.
Yes, we can try the tablet Darifenacin instead of the tablet Mirabegron, and after 15 days we can increase the dose to 15 mg once daily if needed. No, the medicines continue to act as long as they are taken.
I hope this helps.
Thank you.
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Urology
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