The association between urodynamic findings and microvascular complications in patients with long-term type 2 diabetes but without voiding symptoms
Introduction
Diabetic cystopthy, a common complication of long-term diabetes mellitus occurring with a reported frequency of 5–50%, has been classically described as the triad of decreased bladder sensitivity, increased bladder capacity and impaired detrusor contractility [1], [2], [3]. However, many other abnormalities have also been frequently reported in the urodynamic studies of diabetic patients. Examples include increased bladder capacity, increased post-voiding residue, detrusor areflexia and loss of detrusor-external sphincter coordination [4], [5], [6], [7], [8]. The biology of diabetic cystopathy is multifactorial and it can be the result of an alteration in the physiology of the detrusor smooth muscle cell, the innervation or function of the neuronal component or urothelial dysfunction [9].
Despite their importance, detailed and accurate urodynamic studies are time-consuming, costly and invasive. Therefore, finding simple-to-define correlates to predict findings at urodynamic studies in these patients (especially in asymptomatic phases of diabetic cystopathy) is of potentially great value. In this study, we aimed for the first time to assess the association between urodynamic findings and microvascular complications (neuropathy, retinopathy, nephropathy) in patients with long-term type 2 diabetes but without voiding symptoms.
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Patients and methods
A total of 66 patients (26 males and 40 females) with documented type 2 diabetes with no complaint of voiding problems were included in the study. All patients had referred to our diabetes clinic for their routine follow-up. To objectively test for the presence of lower urinary tract symptoms, all patients underwent the International Prostate Symptom Score (IPSS) and those with scores categorized as moderate (8–19) or severe (20–35) were excluded [10]. Patients with fluid intake of more than 3 l
Results
There were 26 male and 40 female patients aging 30–82 years (57.00 ± 9.50). The scores on IPSS ranged from 0 to 6 (all categorized as having mild or no lower urinary tract symptoms [20]), with a mean of 2.15. Male patients were slightly, but not significantly, older (58.85 ± 9.59 years in males against 55.77 ± 9.36 years in females; p = 0.203). The duration of diabetes was 14.44 ± 6.78 years, with a range of 4–32 years. Females suffered from diabetes slightly, but not significantly, longer than males
Discussion
Diabetic cystopathy is marked by insidious onset and progression with minimal symptomatology. Its prevalence is not age or gender specific but is associated with the duration of diabetes, as higher the duration, the more likely the occurrence of cystopathy is [3]. The most common urodynamic findings have been classically described to be impairment of bladder sensation, increased post-void residual volume, decreased detrusor contractility that may progress to detrusor areflexia and diminished
Acknowledgements
This study was supported financially by the grant of Endocrine Research Center (ERC) at Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. The authors wish to thank the personnel of the urodynamic unit for their help in conducting the study. Volunteer diabetic patients are also especially thanked for their participation in the study.
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