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Metabolic Problems: In Particular Diabetic Neuropathy

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Neuro-Urology

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Abstract

The prevalence of metabolic disorders and, in particular, diabetes mellitus is on the rise worldwide. Diabetic bladder dysfunction and its most identifiable type, “diabetic cystopathy,” are quite prevalent in both genders. Although diabetic cystopathy is traditionally characterized by a quartet of symptoms, impaired bladder sensation, increased bladder capacity, infrequent urination, and impaired bladder emptying, epidemiological surveys and clinical and urodynamic studies suggest that diabetic bladder dysfunction is commonly a mixed—storage and voiding—LUTS syndrome, which may follow a time-dependent progression trend. There are strong associations between diabetes and poor glycemic control with the development of urinary incontinence, as well as the prevalence and severity of OAB. Pathophysiological studies provide evidence for myogenic and neurogenic alterations which may be related to a myriad of pathogenetic mechanisms including afferent nerve dysfunction, circadian urine disorders, mitochondrial dysfunction, oxidative stress, interstitial cell dysfunction, and hormonal deficiencies. Interventions which improve glycemic control and components of the metabolic syndrome may result in improvement or resolution of incontinence and LUTS. Although no specific treatments are proposed for diabetic bladder dysfunction, there is evidence that the presence of diabetes may be a negative prognostic factor for the outcomes of pharmacotherapy, minimally invasive treatments, and more invasive surgery for LUTS/incontinence. Patient consultation about the role of good glycemic control should have a key role in the management of diabetic bladder dysfunction.

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Authors and Affiliations

  1. 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Apostolos Apostolidis

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  1. Apostolos Apostolidis
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Editors and Affiliations

  1. Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

    Roger Dmochowski

  2. Department of Urology, Radboud University, Nijmegen, The Netherlands

    John Heesakkers

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Apostolidis, A. (2018). Metabolic Problems: In Particular Diabetic Neuropathy. In: Dmochowski, R., Heesakkers, J. (eds) Neuro-Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-90997-4_7

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  • DOI: https://doi.org/10.1007/978-3-319-90997-4_7

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