In a frail older adult with moderate-to-severe lower urinary tract symptoms, when do you start a beta-3 agonist like vibegron over an anticholinergic?

In a frail older adult with OAB-predominant moderate-to-severe LUTS, I generally start a β3 agonist (vibegron or mirabegron) as the first-line pharmacologic option once behavioral interventions are insufficient. Behavioral therapies may include fluid management, bladder retraining, pelvic floor exer...

For a frail older adult with moderate-to-severe lower urinary tract symptoms (LUTS).

Defining What Matters Most: The Goals of Treatment. Before starting any intervention, it is crucial to define the goals.

For a frail older adult, the primary objectives are:

• Improve Quality of Life: Reduce distress...

Without a doubt, Vibegron and Mirabegron would reduce adverse effects and be much safer in an older, frail adult. The issue will always be cost and insurance coverage. These are expensive medications, and most insurance companies require a trial of their preferred low-cost formulary medication befor...

I offer beta-3 agonists or cystoscopy with intramuscular Botox first. Anticholinergics are rarely ever needed.

Trospium doesn’t cross the blood-brain barrier but does still cause dry mouth and constipation.