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Bethanechol and intermittent straight catheterization
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Bethanechol during the day and oxybutynin at night
No recommendations needed
Oxybutynin and scheduled bathroom breaks
Reduce fluid intake and discontinue diuretics
Select Answer to see Preferred Response
This patient is presenting with symptoms of a neurogenic bladder which is treated with bethanechol and intermittent straight catheterization. A neurogenic bladder typically presents secondary to poorly controlled diabetes. Patients will typically present with incomplete voiding, a distended bladder (with high post-void residual volumes), and constant urinary dribbling. The treatment of choice is to drain the bladder frequently (intermittent self-catheterization) and to increase cholinergic tone to the bladder to aid in its contraction (bethanechol). Incorrect Answer: Answer 2: Bethanechol during the day and oxybutynin at night is inappropriate as oxybutynin will worsen this patient's symptoms. Answer 3: No recommendations needed fails to treat this patient's neurogenic bladder. Answer 4: Oxybutynin and scheduled bathroom breaks would be appropriate for a spastic bladder but would worsen this patient's symptoms of a neurogenic bladder. Answer 5: Reduce fluid intake and discontinue diuretics is inappropriate as it may dehydrate this elderly patient and his angiotensin-converting enzyme (ACE) inhibitor is necessary for nephroprotection. Bullet Summary: Bethanechol and intermittent straight catheterization is the treatment for a neurogenic bladder.
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