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Bladder dysfunction and neuropathy in diabetes


Established urodynamic and electrophysiological techniques have been applied to assess the frequency and extent of autonomic and peripheral neuropathy in 60 subjects with diabetes mellitus; 38 were diabetics with suggestive symptoms and the others were representative newly diagnosed (11) or treated (11) diabetics. Objective evidence of neuropathic bladder dysfunction was detected in 43 of them (71.7%). The commonest abnormality was a hypotonic, insensitive large capacity bladder, which condition was usually asymptomatic. Less frequently (15%) this was complicated by bladder decompensation and sphincter involvement, resulting in excessive residual urine and infection; some of these had bladder paralysis with chronic painless retention of urine (7%). Electrophysiological studies found a sensory defect in the lower limbs in all tested patients (100%), and in 41 patients (69%) an associated motor conduction abnormality, which was more frequent and marked in the lower than the upper limb. These functional abnormalities appeared to be related to the severity of diabetes, but less to its duration. Indeed of 11 newly diagnosed diabetics tested 7 had a peripheral neuropathy and 4 urodynamic abnormalities. The high incidence of bladder dysfunction and peripheral neuropathy in this series indicates the frequency of subclinical diabetic neuropathy and a factor needing more emphasis in diabetic uropathy.


  1. 1.

    Jordan, W. R., Crabtree, H. H.: Paralysis of bladder in diabetic patients. Arch, intern. Med. 55, 17–25 (1935)

    Google Scholar 

  2. 2.

    Rudy, A., Muellner, S. R.: Neurogenic bladder in diabetes mellitus: Early recognition and treatment with report of cases. J. Urol. (Baltimore) 45, 844–857 (1941

    Google Scholar 

  3. 3.

    Rundles, R. W.: Diabetic neuropathy; general review with report of 125 cases. Medicine (Baltimore) 24, 111–160 (1945)

    Google Scholar 

  4. 4.

    Spring, M., Hymes, J.: Neurogenic bladder dysfunction as complication of diabetes; report of 7 cases. Diabetes 2, 199–205 (1953)

    Google Scholar 

  5. 5.

    Larcan, A., Huriet, C., Vaillandet, M., Fauchier, J. P.: Les manifestations vésicales au cours du diabete. Presse méd. 73, 273–276 (1965)

    Google Scholar 

  6. 6.

    Ellenberg, M.: Diabetic neurogenic vesical dysfunction. Ann. intern. Med. (Chicago) 117, 348–354 (1966)

    Google Scholar 

  7. 7.

    Yamagata, S., Kubota, T., Yamauchi, Y., Fukuhara, N.: Early diagnosis of diabetic neuropathy and glomerulosclerosis. Proceedings of the 6th Congress of the International Diabetes Federation, p. 24. (Abstract) Stockholm: Exerpta Medica Foundation 1967

    Google Scholar 

  8. 8.

    Fagerberg, S. E., Kock, N. G., Peteren, I, Steiner, I.: Urinary bladder disturbances in diabetics. I. A comparative study of male diabetics and controls aged between 20 and 50 years. Scand. J. Urol. Nephrol. 1, 19–27 (1967)

    Google Scholar 

  9. 9.

    Lamontagne, A., Buchthal, F.: Electrophysiological studies in diabetic neuropathy. J. Neurol. Neurosurg. Psychiat. 33, 442–452 (1970)

    Google Scholar 

  10. 10.

    Ward, J. D., Barnes, C. G., Fisher, D. J., Jessop, J. D., Baker, R. W. R.: Improvement in nerve conduction following treatment in newly diagnosed diabetics. Lancet 1971 I, 428–430

    Google Scholar 

  11. 11.

    Ellenberg, M., Weber, H.: The incipient asymptomatic diabetic bladder. Diabetes 16, 331–335 (1967)

    Google Scholar 

  12. 12.

    Faerman, I., Maler, M., Jadzinksy, M., Alvarez, E., Fox, D., Zilbervarg, J., Cibeira, J. B., Colinas, R.: Asymptomatic neurogenic bladder in juvenile diabetics. Diabetologia 7, 168–172 (1971)

    Google Scholar 

  13. 13.

    Buck, A. C., McRae, C. U., Reed, P. I., Chisholm, G. D.: Abnormal detrusor function in asymptomatic diabetes. Brit. J. Surg. 60, 310 (1973)

    Google Scholar 

  14. 14.

    Buck, A. C., McRae, C. U., Reed, P. I., Chisholm, G. D.: The diabetic bladder. Proc. roy. Soc. Med. 67, 81–83 (1974)

    Google Scholar 

  15. 15.

    Von Garrelts, B.: Analysis of micturition; a new method of recording the voiding of the bladder. Acta chir. scand. 112, 326–340 (1956)

    Google Scholar 

  16. 16.

    Brown, M., Wickham, J. E. A.: The urethral pressure profile. Brit. J. Urol. 41, 211–217 (1969)

    Google Scholar 

  17. 17.

    Thomas, P. K., Sears, T. A., Gilliatt, R. W.: The range of conduction velocity in normal motor nerve fibres to the small muscles of the hand and foot. J. Neurol. Neurosurg. Psychiat. 22, 175–181 (1959)

    Google Scholar 

  18. 18.

    Gilliatt, R. W., Goodman, H. V., Willison, R. G.: The recording of lateral popliteal nerve action potentials in man. J. Neurol. Neurosurg. Psychiat. 24, 305–318 (1961)

    Google Scholar 

  19. 19.

    Dawson, G. D.: Relative excitability and conduction velocity of sensory and motor nerve fibres in man. J. Physiol. (Lond.) 131, 436–451 (1956)

    Google Scholar 

  20. 20.

    Faerman, I., Gocer, L., Celener, D., Jadzinsky, M., Fox, D., Maler, M., Alvarez, E.: Autonomic nervous system and diabetes. Histological and histochemical study of the autonomic nerve fibres of the urinary bladder in diabetic patients. Diabetes 22, 225–237 (1973)

    Google Scholar 

  21. 21.

    Malins, J. M., Mayne, N.: Diabetic diarrhoea. A study of thirteen patients with jejunal biopsy. Diabetes 18, 858–866 (1969)

    Google Scholar 

  22. 22.

    Whalen, G. E., Soergel, K. H., Geenen, J. E.: Diabetic diarrhoea. A clinical and pathophysiological study. Gastroenterology 56, 1021–1032 (1969)

    Google Scholar 

  23. 23.

    Drewes, V. M.: The small intestine in diabetes mellitus. Copenhagen: Munksgaard 1971

    Google Scholar 

  24. 24.

    Ewing, D. J., Campbell, I. W., Burt, A. A., Clarke, B. F.: Vascular reflexes in diabetic autonomic neuropathy. Lancet 1973 II, 1354–1356

    Google Scholar 

  25. 25.

    Baron, J. H.: Autonomic neuropathy and autovagotomy. Brit, med. J. 3, 408–409 (1974)

    Google Scholar 

  26. 26.

    Gill, R. D.: Diabetic (cord) bladder. J. Urol. (Baltimore) 36, 730–739 (1936)

    Google Scholar 

  27. 27.

    Lich, R. Jr., Grant, O.: Vesical abnormalities incident to diabetes mellitus. J. Urol. (Baltimore) 59, 863–874 (1948)

    Google Scholar 

  28. 28.

    Bates, C. P.: Continence and incontinence. A clinical study of the dynamics of voiding and of the sphincter mechanism. Ann. roy. Coll. Surg. Engl. 49, 18–35 (1971)

    Google Scholar 

  29. 29.

    Balfour, J., Ankenman, G. J.: Atonic neurogenic bladder as a manifestation of diabetic neuropathy. J. Urol. (Baltimore) 76, 746–752 (1956)

    Google Scholar 

  30. 30.

    Rubin, A., Babbott, D.: Impotence and diabetes mellitus. J. Amer. med. Ass. 168, 498–500 (1958)

    Google Scholar 

  31. 31.

    Schöffling, K., Federlin, K., Ditschuneit, H.: Disorders of sexual function in male diabetics. Diabetes 12, 519–527 (1963)

    Google Scholar 

  32. 32.

    Ellenberg, M.: Impotence in diabetes: the neurological factor. Ann. intern. Med. 75, 213–219 (1971)

    Google Scholar 

  33. 33.

    Campbell, I. W., Ewing, D. J., Clarke, B. F., Duncun, L. J. P.: Testicular pain sensation in diabetic autonomic neuropathy. Brit. med. J. 2, 638–639 (1974)

    Google Scholar 

  34. 34.

    Faerman, I., Vilar, O., Rivarola, M. A., Rosner, J., Jadzinsky, M., Fox, D., Perez-Lloret, A., Bernstein-Hahn, L., Saracent, D.: Impotence and diabetes. Studies of androgenic function in diabetic impotent males. Diabetes 21, 23–30 (1972)

    Google Scholar 

  35. 35.

    Bishnu, S. K., Berenyi, M. R.: Circulatory reflex response in diabetic patients with or without peripheral neuropathy. J. Amer. Geriat. Soc. 19, 159–196 (1971)

    Google Scholar 

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Buck, A.C., Reed, P.I., Siddiq, Y.K. et al. Bladder dysfunction and neuropathy in diabetes. Diabetologia 12, 251–258 (1976).

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Key words

  • Diabetic uropathy
  • peripheral neuropathy
  • bladder capacity
  • sensory and motor conduction