Advertisement

Metabolic Problems: In Particular Diabetic Neuropathy

  • Apostolos Apostolidis
Chapter

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.

Keywords

Diabetic cystopathy Diabetic bladder dysfunction Diabetes Lower urinary tract symptoms Incontinence Epidemiology Pathogenesis Metabolic syndrome 

References

  1. 1.
    Daneshgari F, Liu G, Birder L, Hanna-Mitchell AT, Chacko S. Diabetic bladder dysfunction: current translational knowledge. J Urol. 2009;182(6 Suppl):S18–26.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Szczerbinska K, Topinkova E, Brzyski P, van der Roest HG, Richter T, Finne-Soveri H, et al. The characteristics of diabetic residents in European nursing homes: results from the SHELTER study. J Am Med Dir Assoc. 2015;16(4):334–40.CrossRefPubMedGoogle Scholar
  3. 3.
    Ellenberg M. Development of urinary bladder dysfunction in diabetes mellitus. Ann Intern Med. 1980;92(2 Pt 2):321–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Frimodt-Moller C. Diabetic cystopathy: epidemiology and related disorders. Ann Intern Med. 1980;92(2 Pt 2):318–21.CrossRefPubMedGoogle Scholar
  5. 5.
    Drake M, Apostolidis A, Emmanuel A, Gazewski J, Harrison S, Heesakkers J, et al. Neurologic urinary and faecal incontinence. In: Abrams P, Cardozo L, Khoury S, Wein AJ, editors. Incontinence. 5th ed. Paris: ICUD-EAU 2013; 2013. p. 827–1000.Google Scholar
  6. 6.
    Hampel C, Gillitzer R, Pahernik S, Melchior S, Thuroff JW. Diabetes mellitus and bladder function. What should be considered? Urologe A. 2003;42(12):1556–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Bradley WE. Diagnosis of urinary bladder dysfunction in diabetes mellitus. Ann Intern Med. 1980;92(2 Pt 2):323–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Kaplan SA, Te AE, Blaivas JG. Urodynamic findings in patients with diabetic cystopathy. J Urol. 1995;153:342–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Ueda T, Yoshimura N, Yoshida O. Diabetic cystopathy: relationship to autonomic neuropathy detected by sympathetic skin response. J Urol. 1997;157(2):580–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Yamaguchi C, Sakakibara R, Uchiyama T, Yamamoto T, Ito T, Liu Z, et al. Overactive bladder in diabetes: a peripheral or central mechanism? Neurourol Urodyn. 2007;26(6):807–13.CrossRefPubMedGoogle Scholar
  11. 11.
    Brown JS, Nyberg LM, Kusek JW, Burgio KL, Diokno AC, Foldspang A, et al. Proceedings of the national institute of diabetes and digestive and kidney diseases international symposium on epidemiologic issues in urinary incontinence in women. Am J Obstet Gynecol. 2003;188(6):S77–88.CrossRefPubMedGoogle Scholar
  12. 12.
    Bansal R, Agarwal MM, Modi M, Mandal AK, Singh SK. Urodynamic profile of diabetic patients with lower urinary tract symptoms: association of diabetic cystopathy with autonomic and peripheral neuropathy. Urology. 2011;77(3):699–705.CrossRefPubMedGoogle Scholar
  13. 13.
    Lenherr SM, Clemens JQ, Braffett BH, Dunn RL, Cleary PA, Kim C, et al. Glycaemic control and risk of incident urinary incontinence in women with type 1 diabetes: results from the diabetes control and complications trial and epidemiology of diabetes interventions and complications study (DCCT/EDIC). Diabet Med. 2016;33(11):1528–35.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Wang R, Lefevre R, Hacker MR, Golen TH. Diabetes, glycemic control, and urinary incontinence in women. Female Pelvic Med Reconstr Surg. 2015;21(5):293–7.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Saadia Z. Urinary problems amongst gynecological consultations. Association between prolapse, gynecological surgery and diabetes. Med Arch. 2015;69(5):315–8.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Karter AJ, Laiteerapong N, Chin MH, Moffet HH, Parker MM, Sudore R, et al. Ethnic differences in geriatric conditions and diabetes complications among older, insured adults with diabetes: the diabetes and aging study. J Aging Health. 2015;27(5):894–918.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Bani-Issa W, Almomani F, Eldeirawi K. Urinary incontinence among adult women with diabetes in Jordan: epidemiology, correlates and perceived impact on emotional and social Well-being. J Clin Nurs. 2014;23(17–18):2451–60.CrossRefPubMedGoogle Scholar
  18. 18.
    Devore EE, Townsend MK, Resnick NM, Grodstein F. The epidemiology of urinary incontinence in women with type 2 diabetes. J Urol. 2012;188(5):1816–21.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Jackson SL, Scholes D, Boyko EJ, Abraham L, Fihn SD. Urinary incontinence and diabetes in postmenopausal women. Diabetes Care. 2005;28(7):1730–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Lewis CM, Schrader R, Many A, Mackay M, Rogers RG. Diabetes and urinary incontinence in 50- to 90-year-old women: a cross-sectional population-based study. Am J Obstet Gynecol. 2005;193(6):2154–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Hsu A, Conell-Price J, Stijacic Cenzer I, Eng C, Huang AJ, Rice-Trumble K, et al. Predictors of urinary incontinence in community-dwelling frail older adults with diabetes mellitus in a cross-sectional study. BMC Geriatr. 2014;14:137.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Chuang CM, Lin IF, Horng HC, Hsiao YH, Shyu IL, Chou P. The impact of gestational diabetes mellitus on postpartum urinary incontinence: a longitudinal cohort study on singleton pregnancies. BJOG. 2012;119(11):1334–43.CrossRefPubMedGoogle Scholar
  23. 23.
    Chiu AF, Huang MH, Wang CC, Kuo HC. Higher glycosylated hemoglobin levels increase the risk of overactive bladder syndrome in patients with type 2 diabetes mellitus. Int J Urol. 2012;19(11):995–1001.CrossRefPubMedGoogle Scholar
  24. 24.
    Weinberg AE, Leppert JT, Elliott CS. Biochemical measures of diabetes are not independent predictors of urinary incontinence in women. J Urol. 2015;194(6):1668–74.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee SJ, Karter AJ, Thai JN, Van Den Eeden SK, Huang ES. Glycemic control and urinary incontinence in women with diabetes mellitus. J Womens Health (Larchmt). 2013;22(12):1049–55.CrossRefGoogle Scholar
  26. 26.
    Phelan S, Kanaya AM, Ma Y, Vittinghoff E, Barrett-Connor E, Wing R, et al. Long-term prevalence and predictors of urinary incontinence among women in the diabetes prevention program outcomes study. Int J Urol. 2015;22(2):206–12.CrossRefPubMedGoogle Scholar
  27. 27.
    Breyer BN, Phelan S, Hogan PE, Rosen RC, Kitabchi AE, Wing RR, et al. Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: results from the look AHEAD trial. J Urol. 2014;192(1):144–9.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Van Poppel H, Stessens R, Van Damme B, Carton H, Baert L. Diabetic cystopathy: neuropathological examination of urinary bladder biopsies. Eur Urol. 1988;15(1–2):128–31.CrossRefPubMedGoogle Scholar
  29. 29.
    Pittenger G, Vinik A. Nerve growth factor and diabetic neuropathy. Exp Diabesity Res. 2003;4(4):271–85.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Cheng JT, Tong YC. Alterations of nerve-growth factor and p75(NTR) expressions in urinary bladder of fructose-fed obese rats. Neurosci Lett. 2008;441(1):25–8.CrossRefPubMedGoogle Scholar
  31. 31.
    Philyppov IB, Paduraru ON, Gulak KL, Skryma R, Prevarskaya N, Shuba YM. TRPA1-dependent regulation of bladder detrusor smooth muscle contractility in normal and type I diabetic rats. J Smooth Muscle Res. 2016;52:1–17.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Chen W, Jiang C, Jin X, Shen W, Song B, Li L. Roles of stem cell factor on loss of interstitial cells of Cajal in bladder of diabetic rats. Urology. 2011;78(6):1443.e1–6.Google Scholar
  33. 33.
    Vahabi B, McKay NG, Lawson K, Sellers DJ. The role of c-kit-positive interstitial cells in mediating phasic contractions of bladder strips from streptozotocin-induced diabetic rats. BJU Int. 2011;107(9):1480–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Dong X, Song Q, Zhu J, Zhao J, Liu Q, Zhang T, et al. Interaction of Caveolin-3 and HCN is involved in the pathogenesis of diabetic cystopathy. Sci Rep. 2016;6:24844.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54(6):1615–25.CrossRefPubMedGoogle Scholar
  36. 36.
    Rolo AP, Palmeira CM. Diabetes and mitochondrial function: role of hyperglycemia and oxidative stress. Toxicol Appl Pharmacol. 2006;212(2):167–78.CrossRefGoogle Scholar
  37. 37.
    Lee WC, Wu HC, Huang KH, Wu HP, Yu HJ, Wu CC. Hyposensitivity of C-fiber afferents at the distal extremities as an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. PLoS One. 2014;9(1):e86463.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Ishigooka M, Hashimoto T, Hayami S, Suzuki Y, Ichiyanagi O, Nakada T. Thermoreceptor mediated bladder sensation in patients with diabetic cystopathy. Int Urol Nephrol. 1997;29(5):551–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Beylot M, Marion D, Noel G. Ultrasonographic determination of residual urine in diabetic subjects: relationship to neuropathy and urinary tract infection. Diabetes Care. 1982;5(5):501–5.CrossRefPubMedGoogle Scholar
  40. 40.
    Denys MA, Anding R, Tubaro A, Abrams P, Everaert K. Lower urinary tract symptoms and metabolic disorders: ICI-RS 2014. Neurourol Urodyn. 2016;35(2):278–82.CrossRefPubMedGoogle Scholar
  41. 41.
    Mulligan T, Frick MF, Zuraw QC, Stemhagen A, McWhirter C. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006;60(7):762–9.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Haider A, Yassin A, Doros G, Saad F. Effects of long-term testosterone therapy on patients with "diabesity": results of observational studies of pooled analyses in obese hypogonadal men with type 2 diabetes. Int J Endocrinol. 2014;2014:683515.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Parsons JK, Messer K, White M, Barrett-Connor E, Bauer DC, Marshall LM. Obesity increases and physical activity decreases lower urinary tract symptom risk in older men: the osteoporotic fractures in men study. Eur Urol. 2011;60(6):1173–80.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Lenherr SM, Clemens JQ, Braffett BH, Cleary PA, Dunn RL, Hotaling JM, et al. Glycemic control and urinary tract infections in women with type 1 diabetes: results from the DCCT/EDIC. J Urol. 2016;196(4):1129–35.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Ikeda M, Nozawa K. Prevalence of overactive bladder and its related factors in Japanese patients with diabetes mellitus. Endocr J. 2015;62(9):847–54.CrossRefPubMedGoogle Scholar
  46. 46.
    Palleschi G, Pastore AL, Maggioni C, Fuschi A, Pacini L, Petrozza V, et al. Overactive bladder in diabetes mellitus patients: a questionnaire-based observational investigation. World J Urol. 2014;32(4):1021–5.CrossRefPubMedGoogle Scholar
  47. 47.
    Karoli R, Bhat S, Fatima J, Priya S. A study of bladder dysfunction in women with type 2 diabetes mellitus. Indian J Endocrinol Metab. 2014;18(4):552–7.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Ho CH, Tai HC, Yu HJ. Urodynamic findings in female diabetic patients with and without overactive bladder symptoms. Neurourol Urodyn. 2010;29(3):424–7.PubMedGoogle Scholar
  49. 49.
    Lin TL, Chen GD, Chen YC, Huang CN, Ng SC. Aging and recurrent urinary tract infections are associated with bladder dysfunction in type 2 diabetes. Taiwan J Obstet Gynecol. 2012;51(3):381–6.CrossRefPubMedGoogle Scholar
  50. 50.
    Shin YS, On JW, Kim MK. Clinical significance of diabetes mellitus on detrusor functionality on stress urinary incontinent women without bladder outlet obstruction. Int Urogynecol J. 2016;27(10):1557–61.CrossRefPubMedGoogle Scholar
  51. 51.
    Appa AA, Brown JS, Creasman J, Van Den Eeden SK, Subak LL, Thom DH, et al. Clinical predictors and significance of postvoid residual volume in women with diabetes. Diabetes Res Clin Pract. 2013;101(2):164–9.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Golabek T, Kiely E, O'Reilly B. Detrusor overactivity in diabetic and non-diabetic patients: is there a difference? Int Braz J Urol. 2012;38(5):652–9. discussion 60CrossRefPubMedGoogle Scholar
  53. 53.
    Bohlin KS, Ankardal M, Pedroletti C, Lindkvist H, Milsom I. The influence of the modifiable life-style factors body mass index and smoking on the outcome of mid-urethral sling procedures for female urinary incontinence. Int Urogynecol J. 2015;26(3):343–51.CrossRefPubMedGoogle Scholar
  54. 54.
    Schneider T, Marschall-Kehrel D, Hanisch JU, Michel MC. Does concomitant diabetes affect treatment responses in overactive bladder patients? Int J Clin Pract. 2013;67(11):1138–43.CrossRefPubMedGoogle Scholar
  55. 55.
    Wang CC, Liao CH, Kuo HC. Diabetes mellitus does not affect the efficacy and safety of intravesical onabotulinumtoxinA injection in patients with refractory detrusor overactivity. Neurourol Urodyn. 2014;33(8):1235–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Liao CH, Wang CC, Jiang YH. Intravesical OnabotulinumtoxinA injection for overactive bladder patients with frailty, medical comorbidities or prior lower urinary tract surgery. Toxins (Basel). 2016;8(4):91.CrossRefGoogle Scholar
  57. 57.
    Daniels DH, Powell CR, Braasch MR, Kreder KJ. Sacral neuromodulation in diabetic patients: success and complications in the treatment of voiding dysfunction. Neurourol Urodyn. 2010;29(4):578–81.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Apostolos Apostolidis
    • 1
  1. 1.2nd Department of UrologyAristotle University of ThessalonikiThessalonikiGreece

Personalised recommendations