Neuropathy May Predict Diabetic Cystopathy

The presence of peripheral neuropathy was associated with a low urinary flow rate measured urodynamically in the first study to investigate whether microvascular complications can predict the development of cystopathy in diabetic patients without voiding symptoms.

Diabetic cystopathy is a common complication of long-standing diabetes, and traditionally has been described as the triad of decreased bladder sensitivity, increased bladder capacity, and impaired detrusor contractility, according to a study published recently in Diabetes Research and Clinical Practice.

The condition may result from an alteration in physiology of the detrusor smooth muscle cell, from changes in the innervation or function of the neuronal component, or from urothelial dysfunction and multiple other abnormalities that have been reported in urodynamic studies of patients with diabetes (Diabetes Res. Clin. Pract. 2007;78:42–50).

Urodynamic studies are accurate and sensitive, but also are invasive, costly, and time consuming. Easy-to-measure correlates would be potentially valuable in screening for this complication in asymptomatic patients, reported Dr. Alireza Esteghamati of the Endocrine Research Center, Vali-Asr Hospital, Tehran (Iran) University of Medical Sciences, and colleagues.

In order to identify a possible association between bladder abnormalities and microvascular complications, researchers enrolled 66 patients with type 2 diabetes. A total of 40 were female, and their ages ranged from 30 to 82 years. The mean duration of diabetes was 14.4 years. All patients underwent ophthalmologic and neurologic examinations to identify retinopathy and peripheral somatic neuropathy; in addition, 24-hour urine samples were collected to screen for proteinuria. The urodynamic studies consisted of uroflowmetry, filling cystometry, voiding cystometry, and urethral pressure profilometry.

Parameters that were included in the analysis were detrusor activity, bladder capacity, bladder compliance, first sensation of filling, flow rate, bladder outlet status, and postvoiding residue.

Microvascular complications were present in 80.3%, with 71.2% having diabetic neuropathy and 36.4% having retinopathy. Microalbuminuria was present in 32.3% and macroalbuminuria in 15.4%.

All patients had at least one abnormal finding in the urodynamic studies. The prevalence of abnormalities in detrusor activity was 13.6%; in bladder capacity, 84.6%; in bladder compliance, 65.2%; in first sensation of filling, 46.9%; in flow rate, 71%; in bladder outlet obstruction, 11.3%; and in postvoiding residue, 45.5%.

The researchers found that the presence of diabetic neuropathy in the lower limbs was associated with an almost fivefold increased risk of having a low flow rate. Analyses of age, sex, and hemoglobin A_1c, microvascular complications, and urodynamic abnormalities revealed that female sex was associated with increased bladder capacity, while male sex was associated with decreased bladder compliance and bladder outlet obstruction. Older age predicted a low flow rate and outlet obstruction.

The investigators noted that older age and both reduced flow rate and outlet obstruction in men are commonly caused by benign prostatic hypertrophy, but men with a history of this condition had been excluded from their study.

They explained that outlet resistance, which is the primary determinant of flow rate, can vary according to both mechanical factors such as prostatic hypertrophy and functional factors such as sphincteric activity. Sphincteric overactivity, which results in increased outlet resistance and reduced flow rate, is primarily a neuropathic phenomenon and must be considered along with mechanical factors in these patients, the researchers wrote.

The researchers also reported that their findings suggest that diabetic cystopathy begins long before symptoms appear, and wrote, “If, as suggested by our study, microvascular complications cause or are associated with damage to the vascular and neurological innervation of the bladder, then intensive glycemic control may prevent or improve the severity of urologic complications.

The presence of peripheral neuropathy was associated with a low urinary flow rate measured urodynamically in the first study to investigate whether microvascular complications can predict the development of cystopathy in diabetic patients without voiding symptoms.

Diabetic cystopathy is a common complication of long-standing diabetes, and traditionally has been described as the triad of decreased bladder sensitivity, increased bladder capacity, and impaired detrusor contractility, according to a study published recently in Diabetes Research and Clinical Practice.

The condition may result from an alteration in physiology of the detrusor smooth muscle cell, from changes in the innervation or function of the neuronal component, or from urothelial dysfunction and multiple other abnormalities that have been reported in urodynamic studies of patients with diabetes (Diabetes Res. Clin. Pract. 2007;78:42–50).

Urodynamic studies are accurate and sensitive, but also are invasive, costly, and time consuming. Easy-to-measure correlates would be potentially valuable in screening for this complication in asymptomatic patients, reported Dr. Alireza Esteghamati of the Endocrine Research Center, Vali-Asr Hospital, Tehran (Iran) University of Medical Sciences, and colleagues.

In order to identify a possible association between bladder abnormalities and microvascular complications, researchers enrolled 66 patients with type 2 diabetes. A total of 40 were female, and their ages ranged from 30 to 82 years. The mean duration of diabetes was 14.4 years. All patients underwent ophthalmologic and neurologic examinations to identify retinopathy and peripheral somatic neuropathy; in addition, 24-hour urine samples were collected to screen for proteinuria. The urodynamic studies consisted of uroflowmetry, filling cystometry, voiding cystometry, and urethral pressure profilometry.

Parameters that were included in the analysis were detrusor activity, bladder capacity, bladder compliance, first sensation of filling, flow rate, bladder outlet status, and postvoiding residue.

Microvascular complications were present in 80.3%, with 71.2% having diabetic neuropathy and 36.4% having retinopathy. Microalbuminuria was present in 32.3% and macroalbuminuria in 15.4%.

All patients had at least one abnormal finding in the urodynamic studies. The prevalence of abnormalities in detrusor activity was 13.6%; in bladder capacity, 84.6%; in bladder compliance, 65.2%; in first sensation of filling, 46.9%; in flow rate, 71%; in bladder outlet obstruction, 11.3%; and in postvoiding residue, 45.5%.

The researchers found that the presence of diabetic neuropathy in the lower limbs was associated with an almost fivefold increased risk of having a low flow rate. Analyses of age, sex, and hemoglobin A_1c, microvascular complications, and urodynamic abnormalities revealed that female sex was associated with increased bladder capacity, while male sex was associated with decreased bladder compliance and bladder outlet obstruction. Older age predicted a low flow rate and outlet obstruction.

The investigators noted that older age and both reduced flow rate and outlet obstruction in men are commonly caused by benign prostatic hypertrophy, but men with a history of this condition had been excluded from their study.

They explained that outlet resistance, which is the primary determinant of flow rate, can vary according to both mechanical factors such as prostatic hypertrophy and functional factors such as sphincteric activity. Sphincteric overactivity, which results in increased outlet resistance and reduced flow rate, is primarily a neuropathic phenomenon and must be considered along with mechanical factors in these patients, the researchers wrote.

The researchers also reported that their findings suggest that diabetic cystopathy begins long before symptoms appear, and wrote, “If, as suggested by our study, microvascular complications cause or are associated with damage to the vascular and neurological innervation of the bladder, then intensive glycemic control may prevent or improve the severity of urologic complications.

The presence of peripheral neuropathy was associated with a low urinary flow rate measured urodynamically in the first study to investigate whether microvascular complications can predict the development of cystopathy in diabetic patients without voiding symptoms.

Diabetic cystopathy is a common complication of long-standing diabetes, and traditionally has been described as the triad of decreased bladder sensitivity, increased bladder capacity, and impaired detrusor contractility, according to a study published recently in Diabetes Research and Clinical Practice.

The condition may result from an alteration in physiology of the detrusor smooth muscle cell, from changes in the innervation or function of the neuronal component, or from urothelial dysfunction and multiple other abnormalities that have been reported in urodynamic studies of patients with diabetes (Diabetes Res. Clin. Pract. 2007;78:42–50).

Urodynamic studies are accurate and sensitive, but also are invasive, costly, and time consuming. Easy-to-measure correlates would be potentially valuable in screening for this complication in asymptomatic patients, reported Dr. Alireza Esteghamati of the Endocrine Research Center, Vali-Asr Hospital, Tehran (Iran) University of Medical Sciences, and colleagues.

In order to identify a possible association between bladder abnormalities and microvascular complications, researchers enrolled 66 patients with type 2 diabetes. A total of 40 were female, and their ages ranged from 30 to 82 years. The mean duration of diabetes was 14.4 years. All patients underwent ophthalmologic and neurologic examinations to identify retinopathy and peripheral somatic neuropathy; in addition, 24-hour urine samples were collected to screen for proteinuria. The urodynamic studies consisted of uroflowmetry, filling cystometry, voiding cystometry, and urethral pressure profilometry.

Parameters that were included in the analysis were detrusor activity, bladder capacity, bladder compliance, first sensation of filling, flow rate, bladder outlet status, and postvoiding residue.

Microvascular complications were present in 80.3%, with 71.2% having diabetic neuropathy and 36.4% having retinopathy. Microalbuminuria was present in 32.3% and macroalbuminuria in 15.4%.

All patients had at least one abnormal finding in the urodynamic studies. The prevalence of abnormalities in detrusor activity was 13.6%; in bladder capacity, 84.6%; in bladder compliance, 65.2%; in first sensation of filling, 46.9%; in flow rate, 71%; in bladder outlet obstruction, 11.3%; and in postvoiding residue, 45.5%.

The researchers found that the presence of diabetic neuropathy in the lower limbs was associated with an almost fivefold increased risk of having a low flow rate. Analyses of age, sex, and hemoglobin A_1c, microvascular complications, and urodynamic abnormalities revealed that female sex was associated with increased bladder capacity, while male sex was associated with decreased bladder compliance and bladder outlet obstruction. Older age predicted a low flow rate and outlet obstruction.

The investigators noted that older age and both reduced flow rate and outlet obstruction in men are commonly caused by benign prostatic hypertrophy, but men with a history of this condition had been excluded from their study.

They explained that outlet resistance, which is the primary determinant of flow rate, can vary according to both mechanical factors such as prostatic hypertrophy and functional factors such as sphincteric activity. Sphincteric overactivity, which results in increased outlet resistance and reduced flow rate, is primarily a neuropathic phenomenon and must be considered along with mechanical factors in these patients, the researchers wrote.

The researchers also reported that their findings suggest that diabetic cystopathy begins long before symptoms appear, and wrote, “If, as suggested by our study, microvascular complications cause or are associated with damage to the vascular and neurological innervation of the bladder, then intensive glycemic control may prevent or improve the severity of urologic complications.