Urologic Complications of Diabetes
- Jeanette S. Brown, MD1,
- Hunter Wessells, MD2,
- Michael B. Chancellor, MD3,
- Stuart S. Howards, MD4,
- Walter E. Stamm, MD2,
- Ann E. Stapleton, MD2,
- William D. Steers, MD4,
- Stephen K. Van Den Eeden, PHD5 and
- Kevin T. McVary, MD, FACS6
- 1University of California, San Francisco, California
- 2University of Washington, Seattle, Washington
- 3University of Pittsburgh, Pittsburgh, Pennsylvania
- 4University of Virginia, Charlottesville, Virginia
- 5Division of Research, Kaiser Permanente, Oakland, California
- 6Northwestern University, Chicago, Illinois
- Address correspondence and reprint requests to Jeanette S. Brown, MD, University of California, San Francisco, 1635 Divisadero St., Suite 600, San Francisco, CA 94115. E-mail: brownj{at}obgyn.ucsf.edu
- AGE, advanced glycation end product
- ASB, asymptomatic bacteriuria
- BPH, benign prostatic hyperplasia
- DPP, Diabetes Prevention Program
- ED, erectile dysfunction
- EDIC, Epidemiology of Diabetes Interventions and Complications Study
- ET-1, endothelin-1
- IGT, impaired glucose tolerance
- IL, interleukin
- LUTS, lower urinary tract symptoms
- NGF, nerve growth factor
- NOS, nitric oxide synthase
- PKC, protein kinase C
- PMN, polymorphonuclear leukocyte
- STZ, streptozotocin
Diabetes and urologic diseases are very common health problems that markedly increase in prevalence and incidence with advancing age (1–3). Diabetes is associated with an earlier onset and increased severity of urologic diseases, resulting in costly and debilitating urologic complications. Urologic complications, including bladder dysfunction, sexual and erectile dysfunction, as well as urinary tract infections (UTIs), have a profound effect on the quality of life of men and women with diabetes. This review presents a comprehensive overview of the current understanding of clinical and basic research on urologic complications of diabetes and recommendations for future directions for research and clinical care.
BLADDER DYSFUNCTION
Over 50% of men and women with diabetes have bladder dysfunction (4,5). Current understanding of bladder dysfunction reflects a progressive condition encompassing a broad spectrum of lower urinary tract symptoms including urinary urgency, frequency, nocturia, and incontinence. Previously, the dysfunction has been classically described as diminished bladder sensation, poor contractility, and increased postvoid residual urine, termed bladder cystopathy (6). However, bladder cystopathy most likely represents end-stage bladder failure with symptoms of infrequent voiding, difficulty initiating voiding, and postvoid fullness and is relatively uncommon.
A number of clinical studies in men and women with diabetes have reported bladder instability or hypersensitivity as the most frequent finding, ranging from 39–61% of subjects (5,7). Diminished bladder contractility or sensation has been found less often (5), and an acontractile bladder appears to be quite uncommon.
Bladder dysfunction in women
In women, urinary incontinence is estimated to affect nearly 50% of middle aged and older women, leading to significant distress, limitations in daily functioning, and poorer quality of life (8,9). Diabetes has been identified as an important independent risk factor for incontinence in several large observational studies, including the Nurses’ Health Study, and is associated with 30–100% increased risk (9 …
