Doctors are people too, and even those with the best intentions might not always understand how a drug, medical device or surgery can affect some patients. For this reason, it is always best to be prepared when visiting your health care provider.
When faced with a neurogenic bladder, doctors may offer a few treatment options to patients. Any treatment that promises a better quality of life can be attractive. But, while some of these treatments may offer benefits, they may also harbor unknown risks. In the case of neurogenic bladder, doctors may recommend fluoroquinolone antibiotics for chronic urinary tract infections or a mesh bladder sling for incontinence. Studies have shown that while there are some benefits to these therapies, the side effects might outweigh them.
Here is some information on these two treatments that can help you be your own advocate.
Fluoroquinolones
Fluoroquinolones are the most commonly used type of antibiotic in the U.S. They include drugs such as Cipro (ciprofloxacin), Levaquin (levofloxacin), and Avelox (moxifloxacin). The most popular of these drugs is Cipro and it makes up 80 percent of all prescriptions. These drugs are popular because they treat a wide variety of bacterial infections. It is the preferred treatment for urinary tract infections (UTIs) and bladder infections. But these drugs also come with a long list of side effects.
For individuals who already suffer nerve-related conditions like neurogenic bladder or bowel, these drugs can be catastrophic. In studies, fluoroquinolones are linked to peripheral neuropathy - a type of nerve damage that can be permanent. It causes poor bowel and bladder control, burning pain, organ and gland dysfunction as well as digestive issues. In 2013, the FDA added a warning to fluoroquinolone labels advising of the risk.
Other serious issues related to these antibiotics are tendon rupture and aortic aneurysms and dissections - bulges and tears in the aorta. The FDA has a black-box warning for tendon rupture associated with fluoroquinolones. A study in JAMA medical journal showed these drugs can cause a two-fold increased risk of dissection and aneurysm in the first 60 days after taking one of these drugs.
Fortunately, these are not the only antibiotics and treatments available for urinary tract infections. Some of these include trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS), nitrofurantoin monohydrate/macrocrystals (Macrobid) and fosfomycin tromethamine (Monurol). Keep in mind, no drug is free of side effects, but patients should be able to make a decision based on risks and benefits with their doctors.
Bladder Slings
Bladder slings, also called bladder neck slings or transvaginal mesh slings, are one of the surgical treatments for neurogenic incontinence. This treatment is more common in female adults and children diagnosed with the condition, but some males also undergo the procedure. Doctors use the patient's own tissue or a synthetic plastic mesh implant to support the bladder neck and help it close to prevent urine from leaking.
One study in the Journal of Urology showed a high rates of success - 70 and 90 percent - in treating incontinence after surgery. Study authors found the sling "safe [and] relatively easy to perform and cost-effective compared with most alternative procedures."
However, the FDA has also received thousands of reports of women who suffered severe complications. These include mesh erosion, nerve and organ damage, severe pelvic pain, hemorrhaging and other issues. Surgery to remove the implant and repair damaged tissues is costly and carries its own complications.
Many of these women filed lawsuits against mesh makers for failing to warn them about the risks. When considering a surgical treatment, make sure you use a doctor who specializes in these types of surgeries and can discuss the risks and benefits. Make sure to get multiple opinions if necessary. Surgeries using the patient's own tissue may have fewer complications than one with synthetic implant.
Be Your Own Advocate
In her book, Beyond Embarrassment, JoAnne Lake discusses her own struggles with being prescribed a fluoroquinolone for a bladder infection and discussing her treatment options with her doctor.
"My body had enough problems, and I was not willing to risk having painful cartilage issues along with all the other things going on," JoAnne wrote. "My doctor was quite offended when I would not take his drug of choice, and he refused to offer an alternative."
JoAnne shares the importance of having a doctor who will listen and be willing to work with the patient. Patients need to be their own advocates, she says. Sometimes, this means going through a number of doctors before finding the right one. It also means being an active participant in treatment.
Fortunately, the internet is a great resource. Read up on any prescriptions and procedures and be ready with questions.
Bio: Michelle Y. Llamas is a writer and researcher for Drugwatch.com. She is also the host of Drugwatch Radio and has appeared as a guest on podcasts and radio shows. Her work has appeared in peer-review journals.Sources:
Castellan, M. et al. (2005). Bladder neck sling for treatment of neurogenic incontinence in children with augmentation cystoplasty: long-term followup. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15879865
Dik, P. et al. (2003). Transvaginal sling suspension of Bladder Neck in Female Patients with Neurogenic Sphincter Incontinence. Retrieved from http://www.jurology.com/article/S0022-5347(05)63392-7/abstract
The Medical Letter. (2012). Drugs for Urinary Tract Infections. Retrieved from http://secure.medicalletter.org/w1395a