Investigation of Urodynamic Characteristics and Bladder Sensory Function in the Early Stages of Diabetic Bladder Dysfunction in Women With Type 2 Diabetes

Purpose

We studied urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in diabetic women.

Materials and Methods

A total of 86 consecutive type 2 diabetic women with minimal confounders of voiding dysfunction followed at a diabetes clinic were prospectively enrolled and subjected to urodynamic studies. The sensory response of Aδ and C fibers of the bladder was measured by intravesical current perception threshold testing at frequencies of 250 and 5 Hz, respectively.

Results

Of these 86 women 30 (34.9%) were classified as having detrusor underactivity, 12 (14.0%) presented signs of detrusor overactivity, 11 (12.8%) were referred to as having bladder outlet obstruction and 33 (38.4%) showed normal detrusor function on urodynamics. The normal detrusor function group was the reference group. The detrusor underactivity group showed impaired emptying function and decreased sensation on cystometry and intravesical current perception threshold testing. The detrusor overactivity group showed impaired storage and emptying function but had no significant changes in intravesical current perception threshold values. When the normal detrusor function group and detrusor underactivity group were pooled to perform multivariate analysis, an increase in current perception threshold values was associated with a decrease in bladder voiding efficiency on 5 and 250 Hz current perception threshold testing.

Conclusions

Our data provide the electrophysiological evidence that indicates an association between impaired Aδ as well as C fiber bladder afferent pathways and poor emptying function in diabetic women with detrusor underactivity. Diabetes can affect the bladder presumably via peripheral pathogenetic mechanisms to induce detrusor overactivity with impaired contractility.

Key Words: diabetes mellitus, urinary bladder, urination disorders, diabetic neuropathies

Abbreviations and Acronyms: BOO, bladder outlet obstruction, BVE, bladder voiding efficiency, CPT, current perception threshold, DBD, diabetic bladder dysfunction, DO, detrusor overactivity, DU, detrusor underactivity, ICS, International Continence Society, MUCP, maximum urethral closing pressure, NDF, normal detrusor function, NGF, nerve growth factor, PdetQmax, detrusor pressure at maximum uroflow rate, PVR, post-void residual urine volume, Qmax, maximum uroflow rate, Qmax/TQmax, the acceleration of uroflow, TQmax, time to maximum flow