The association between urodynamic findings and microvascular complications in patients with long-term type 2 diabetes but without voiding symptoms

doi:10.1016/j.diabres.2007.02.011

Diabetes Research and Clinical Practice

Volume 78, Issue 1, October 2007, Pages 42-50

https://doi.org/10.1016/j.diabres.2007.02.011 Get rights and content

Abstract

Diabetic cystopathy is a common complication of diabetes mellitus, which is assessable by urodynamic study. The purpose of this study was to determine the association between urodynamic findings and microvascular complications (neuropathy, retinopathy, nephropathy) in patients with long-term type 2 diabetes but without voiding symptoms. A total of 66 consecutive patients (26 males and 40 females, age 57.00 ± 9.50 years, diabetes duration 14.44 ± 6.78 years) with documented type 2 diabetes, low scores at the International Prostate Symptom Score (IPSS) and no subjective complaint of voiding problems were included in the study. Seven urodynamic parameters were considered: detrusor activity, bladder capacity, bladder compliance, first sensation of filling, flow rate, bladder outlet status and post-voiding residue. The following independent associations were found: between female sex and increased bladder capacity (p = 0.004), between male sex and both decreased bladder compliance (p = 0.023) and bladder outlet obstruction (p = 0.001), between old age and both low flow rate (p = 0.022) and outlet obstruction (p = 0.047), between detrusor instability and shorter duration of diabetes (p = 0.044) and between peripheral somatic neuropathy and low flow rate (OR = 5.208; 95%CI = 1.277–21.277). The Spearman's correlation coefficient for the latter association was 0.356 (p = 0.005) and remained significant even after controlling for age, sex, HbA1c and diabetes duration (ρ = 0.310; p = 0.019). In conclusion, searching for microvascular complications might be used to screen for some components of diabetic cystopathy in its asymptomatic phase.

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.

Section snippets

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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The association between urodynamic findings and microvascular complications in patients with long-term type 2 diabetes but without voiding symptoms

Abstract

Introduction

Section snippets

Patients and methods

Results

Discussion

Acknowledgements

J. Urol.

J. Urol.

J. Diabet. Complications

J. Urol.

Diabetic cystopathy. A review of the urodynamic and clinical features of neurogenic bladder dysfunction in diabetes mellitus

Dan. Med. Bull.

Campbell's Urology

Diabetic cystopathy: epidemiology and related disorders

Ann. Intern. Med.

Vesicourethral dysfunction of diabetic patients

Nippon Hinyokika Gakkai Zasshi

Vesicourethral function in diabetic patients: association of abnormal nerve conduction velocity with vesicourethral dysfunction

Neurourol. Urodyn.

Diabetic cystopathy. I. A clinical study on the frequency of bladder dysfunction in diabetes

Dan. Med. Bull.