Urological Care for Patients with Diabetes-Induced Lower Urinary Tract Dysfunction

  • Kelly Bree
  • Yahir Santiago-LastraEmail author


Diabetic cystopathy is a common and costly complication of the disease. The main driver for bladder dysfunction in this disease process is hyperglycemia. This leads to tissue damage in particularly susceptible cells. In diabetic cystopathy, hyperglycemia contributes to progressive loss of nerve fibers, which affects both the autonomic and somatic divisions of the nervous system. Urologic sequelae of diabetes include lower urinary tract dysfunction as well as sexual dysfunction. The process is slowly progressive and insidious. A common finding is impaired bladder sensation, which can lead to an asymptomatic increase in bladder capacity and urinary retention. The detrusor remodeling that occurs can also cause overactive bladder symptoms. Symptom presentation is widely variable and may go unnoticed for many years. Urodynamics can be the cornerstone of diagnosis in many cases. Treatments vary depending on subtype of bladder dysfunction and generally have lower success rates due to the irreversible loss of detrusor sensory and contractile ability.


Diabetes Urodynamics Bladder dysfunction Incontinence Urinary retention Hyperglycemia 


  1. 1.
    Centers for Disease Control and Prevention. Diabetes report card 2017; 2017. Accessed 22 Oct 2018.
  2. 2.
    Skyler JS, Bakris GL, Bonifacio E, et al. Differentiation of diabetes by pathophysiology, natural history, and prognosis. Diabetes. 2017;66(2):241–55. Scholar
  3. 3.
    Brownlee M. The pathobiology of diabetic complications a unifying mechanism.; 2004. Accessed 22 Oct 2018.
  4. 4.
    Charnogursky GA, Emanuele N V, Emanuele MA. Neurologic complications of diabetes. doi:
  5. 5.
    Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Diabetic neuropathies: diagnosis and management. Neuroendocrinology. 2013;98(4):267–80. Scholar
  6. 6.
    Yuan Z, Tang Z, He C, Tang W. Diabetic cystopathy: a review. J Diabetes. 2015;7(4):442–7. Scholar
  7. 7.
    Liu RT, Chung MS, Lee WC, et al. Prevalence of overactive bladder and associated risk factors in 1359 patients with type 2 diabetes. Urology. 2011;78(5):1040–5. Scholar
  8. 8.
    Kebapci N, Yenilmez A, Efe B, Entok E, Demirustu C. Bladder dysfunction in type 2 diabetic patients. Neurourol Urodyn. 2007;26:814–9.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Wittig L, Carlson KV, Andrews JM, Crump RT, Baverstock RJ. Diabetic bladder dysfunction: a review. Urology. 2018:10–5.
  10. 10.
    Daneshgari F, Liu G, Birder L, Hanna-Mitchell AT, Chacko S. Diabetic bladder dysfunction: current translational knowledge HHS Public. Access J Urol. 2009;182:18–26. Scholar
  11. 11.
    Golbidi S, Laher I, Ohlstein E. Bladder dysfunction in diabetes mellitus. Article. 2010;(1):1.
  12. 12.
    Winters JC, Dmochowski RR, Goldman HB, et al. AUA/SUFU guideline: adult urodynamics. Am Urol Assoc. 2012:1–30.
  13. 13.
    Dong X, Song Q, Zhu J, et al. Interaction of Caveolin-3 and HCN is involved in the pathogenesis of diabetic cystopathy. OPEN Nat Publ Gr. 2016;
  14. 14.
    Lee WC, Wu HP, Tai TY, Yu HJ, Chiang PH. Investigation of urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in women with type 2 diabetes. J Urol. 2009;181(1):198–203. Scholar
  15. 15.
    Brown JS, Wing R, Barrett-Connor E, et al. Lifestyle intervention is associated with lower prevalence of urinary incontinence. Diabetes Care. 2006;29(2).Google Scholar
  16. 16.
    Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the Incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. Scholar
  17. 17.
    Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS. Weight loss: a novel and effective treatment for urinary incontinence. J Urol. 2005;174(1):190–5. Scholar
  18. 18.
    Cameron AP. Medical management of neurogenic bladder with oral therapy. Transl Androl Urol. 2016;5(1):51–62. Scholar
  19. 19.
    Miyazato M, Yoshimura N, Chancellor MB. The other bladder syndrome: underactive bladder. Rev Urol. 2013;15(1):11–22. Scholar
  20. 20.
    Wai CY, Curto TM, Zyczynski HM, et al. Patient satisfaction after midurethral sling surgery for stress urinary incontinence. Obstet Gynecol. 2013;121(5):1009–16. Scholar
  21. 21.
    Kokanali MK, Doǧanay M, Aksakal O, Cavkaytar S, Topçu HO, Özer I. Risk factors for mesh erosion after vaginal sling procedures for urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2014;177:146–50. Scholar
  22. 22.
    Masumori N, Furuya R, Tanaka Y, Furuya S, Ogura H, Tsukamoto T. The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery. BJU Int. 2010;105(10):1429–33. Scholar
  23. 23.
    Gani J, Hennessey D. The underactive bladder: diagnosis and surgical treatment options. Transl Androl Urol. 2017;6(S2):S186–95. Scholar
  24. 24.
    Daniels DH, Powell CR, Braasch MR, Kreder KJ. Sacral neuromodulation in diabetic patients: success and complications in the treatment of voiding dysfunction. Neurourol Urodyn. 2010;29:578–81. Scholar
  25. 25.
    Dronge AS, S M CB, PK W MB, MP Y. Long-term glycemic control and postoperative infectious complications. Arch Surg. 2006;141(4):375. Scholar
  26. 26.
    Feringa HHH, Vidakovic R, Karagiannis SE, et al. Impaired glucose regulation, elevated glycated haemoglobin and cardiac ischaemic events in vascular surgery patients. Diabet Med. 2008;25(3):314–9. Scholar
  27. 27.
    Sudhakaran S, Surani SR. Guidelines for the management of the diabetic patient. Surg Res Pract 2015;2015.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.University of California – San Diego HealthLa JollaUSA

Personalised recommendations