From the Guidelines
Uncontrolled Diabetes Mellitus can lead to diabetic cystopathy, causing symptoms like urinary frequency and dysuria due to neuropathy affecting bladder function, with approximately 43-87% of type 1 diabetic patients and 25% of type 2 diabetic patients developing some form of bladder dysfunction. The pathophysiology involves hyperglycemia-induced damage to the autonomic nerves that control bladder function, resulting in detrusor muscle dysfunction and altered bladder sensation 1.
Key Points
- Diabetic cystopathy is a common complication of diabetes, with a significant impact on quality of life, and is associated with peripheral neuropathy, retinopathy, and diabetes duration 1.
- Symptoms of diabetic cystopathy include urinary frequency, urgency, and burning sensations during urination, as well as voiding difficulties, weak stream, and post-void residual (PVR) 1.
- Management of diabetic cystopathy typically involves tight glycemic control with target HbA1c below 7%, regular urological evaluations, and potentially medications like antimuscarinic agents for overactive bladder symptoms or alpha-blockers for obstructive symptoms.
- Early detection through regular screening of diabetic patients for urinary symptoms is crucial, as diabetic cystopathy can lead to urinary tract infections, urinary retention, and kidney damage if left untreated 1.
Recommendations
- Regular screening for urinary symptoms should be performed in all diabetic patients, particularly those with a long duration of diabetes or peripheral neuropathy.
- Tight glycemic control and regular urological evaluations are essential for preventing and managing diabetic cystopathy.
- Medications like antimuscarinic agents or alpha-blockers may be necessary to manage symptoms of overactive bladder or obstructive symptoms.
- Intermittent catheterization is the treatment of choice for acontractile bladder, and PVR and urine dipstick (optional culture) should be performed yearly in all patients with insulin-dependent diabetes 1.
From the Research
Diabetic Cystopathy and Its Symptoms
- Uncontrolled Diabetes Mellitus can lead to diabetic cystopathy, a common chronic complication of diabetes mellitus, characterized by a variety of lower urinary tract symptoms 2, 3, 4, 5, 6.
- The classic symptoms of diabetic cystopathy include decreased bladder sensation, increased bladder capacity, and impaired bladder emptying with resultant increased post-void residual volume 2, 3.
- Recent clinical evidence indicates that diabetic cystopathy can also present with storage symptoms, such as overactive bladder symptoms, urgency, and urge incontinence 2, 4, 6.
- Urinary frequency and dysuria can be symptoms of diabetic cystopathy, likely caused by neuropathy affecting bladder function, which can lead to voiding dysfunction in diabetic individuals 2, 4, 5.
Pathophysiology and Treatment
- The pathophysiology of diabetic cystopathy is multifactorial, including disturbances of the detrusor, neuron, urothelium, and urethra, as well as hyperglycemia, oxidative stress, and polyuria 2, 4, 5.
- Treatment of diabetic cystopathy depends on clinical symptoms and urodynamic abnormalities, and may include timed voiding, clean intermittent catheterization, pharmacologic, and surgical interventions 2, 3, 6.
- Urodynamic evaluation is the cornerstone of diagnosis and determines management strategies for diabetic cystopathy 2, 3.