Urological Care for Patients with Diabetes-Induced Lower Urinary Tract Dysfunction
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.
KeywordsDiabetes Urodynamics Bladder dysfunction Incontinence Urinary retention Hyperglycemia
- 1.Centers for Disease Control and Prevention. Diabetes report card 2017; 2017. www.cdc.gov/diabetes/library/reports/congress.html. Accessed 22 Oct 2018.
- 3.Brownlee M. The pathobiology of diabetic complications a unifying mechanism.; 2004. http://diabetes.diabetesjournals.org/content/54/6/1615.full-text.pdf. Accessed 22 Oct 2018.
- 4.Charnogursky GA, Emanuele N V, Emanuele MA. Neurologic complications of diabetes. doi: https://doi.org/10.1007/s11910-014-0457-5.
- 11.Golbidi S, Laher I, Ohlstein E. Bladder dysfunction in diabetes mellitus. Article. 2010;(1):1. https://doi.org/10.3389/fphar.2010.00136.
- 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; https://doi.org/10.1038/srep24844.
- 18.Cameron AP. Medical management of neurogenic bladder with oral therapy. Transl Androl Urol. 2016;5(1):51–62. https://doi.org/10.3978/j.issn.2223-4683.2015.12.07.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1111/j.1464-410X.2009.08978.x.CrossRefPubMedGoogle Scholar
- 27.Sudhakaran S, Surani SR. Guidelines for the management of the diabetic patient. Surg Res Pract 2015;2015.Google Scholar