A comprehensive review of urologic complications in patients with diabetes

Abstract

Diabetes Mellitus (DM) is a chronic disease characterized by hyperglycemia, as a result of abnormal insulin production, insulin function, or both. DM is associated with systemic complications, such as infections, neuropathy and angiopathy, which involve the genitourinary tract. The three most significant urologic complications include: bladder cystopathy, sexual dysfunction and urinary tract infections.Almost half of the patients with DM have bladder dysfunction or cystopathy, which can be manifested in women as hypersensitivity (in 39–61% of the diabetic women) or neurogenic bladder. In males it can be experienced as lower urinary tract symptoms (in 25% of diabetic males with a nearly twofold increased risk when seen by age groups). Additionally, an increased prostate volume affects their micturition as well as their urinary tract.Involving sexual dysfunction in women, it includes reduced libido, decreased arousal, clitoral erectile dysfunction and painful or non-sensitive intercourse; and in diabetic males it varies from low libido, ejaculatory abnormalities and erectile dysfunction. Globally, sexual disorders have a prevalence of 18–42%. Erectile dysfunction is ranked as the third most important complication of DM. Urinary tract infections are observed frequently in diabetic patients, and vary from emphysematous infections, Fournier gangrene, staghorn infected lithiasis to repetitive bacterial cystitis. The most frequent finding in diabetic women has been lower urinary tract infections. Because of the high incidence of obesity worldwide and its association with diabetes, it is very important to keep in mind the urologic complication associated with DM in patients, in order to better diagnose and treat this population.

Chronic pudendal neuromodulation using an implantable microstimulator improves voiding function in diabetic rats

“…These findings reveal that DSD occurred in the diabetic rats. DSD may increase voiding time and residual urine and reduce VE, leading to chronic bladder overdistention in patients with diabetes [33]; these clinical symptoms were detected in our results.…”

Lower urinary tract symptoms and metabolic disorders: ICI-RS 2014

“…These variations are related to oscillations in connexin‐43, a protein associated with changes in functional bladder capacity . Diabetic cystopathy is an example of a link between changes in functional bladder capacity and metabolic disorders . It manifests as an impaired bladder sensation, which leads to an increased bladder capacity and urinary retention that usually occurs asymptomatically until they have a secondary urinary tract infection …”

Neurogenic Causes of Detrusor Underactivity

“…It is known that up to 50% of men and women with DM will develop diabetic cystopathy, also known as diabetic bladder dysfunction 18, 19 . The types of diabetic bladder dysfunction range widely from sensory-urgency to impaired bladder emptying with eventual DU 18 . The onset of diabetic cystopathy can be insidious, occurring sometimes early after the onset of DM 20 .…”