Dr. Jason Kim

We're lucky here that on Long Island, we have a very, very robust network of pelvic floor physical therapists.

So for us, it's really not an issue finding a good pelvic floor physical therapist.

I think it's important to stress to patients that if they're going to go for pelvic floor physical therapy, that they find a place that actually specializes in pelvic floor PT.

Yeah, I agree 100%.

Yeah, it depends on the situation.

We all know the JAMA article from a few years ago shows that there's a higher risk of cognitive dysfunction in older patients.

For the most part in older patients, I try to stick to the beta-3 agonists.

As you know now, merbegron is generic, so that helps a lot.

However, I have found that even generic merbegron can be pricey, depending on insurance brands and things.

If that doesn't work, we'll try to use Gemtessa.

I'll be honest, the coverage seems to be hit or miss.

When it's covered, it's great.

When it's not, it's extremely expensive.

I will typically reserve the use of anticholinergics, maybe in the younger patient cohort.

It's amazing how many older patients come to me on something like oxybutynin.

They've been on it for 20 years.

It's not working.

They're older patients, and they never heard about the side effects of oxybutynin, especially the cognitive side effects.

And once I counsel them on that, they say, I don't want to be on that medication.

So, I mean, I try in older patients to start beta-3s.