Impact of Diabetes and Obesity on the Prostate and Urethra: Implications to Improved Bladder Dysfunction Understanding and Treatment

Purpose

Alterations in bladder function are well documented in response to diabetes and obesity. Nonetheless, clinical manifestations of bladder dysfunction are diverse and the efficacy of available therapy is suboptimal. Since the bladder is only 1 component of the lower urinary tract, we explored existing evidence for the potential contribution(s) of other major lower urinary tract structures to diabetes and obesity related bladder dysfunction, namely the prostate and the urethra.

Materials and Methods

We performed a MEDLINE® database search of the relevant literature.

Results

A relatively large literature exists on bladder dysfunction and the urethra. However, when additional search terms were added, such as prostate, diabetes and obesity, there was a dramatic decrease in the number of retrieved citations. These observations are consistent with the vanishingly small available literature on the impact of diabetes on prostatic biology and urethral function, and their potential impact on bladder physiology/dysfunction. The available literature documents significant alterations in prostatic biology and urethral function in the setting of diabetes and/or obesity.

Conclusions

The observed diversity in diabetes and obesity related bladder dysfunction, and the variable efficacy of currently available treatments may be related at least in part to the differential impact of these disease states on the complex integration of bladder function with other structural components of the lower urinary tract, namely the urethra and the prostate. More comprehensive investigations of this system should lead to improved understanding of the mechanistic basis for the observed pathophysiology and identify novel treatment regimens.

Key Words: urethra, prostate, diabetes mellitus, obesity, urinary bladder

Abbreviations and Acronyms: BPH, benign prostatic hyperplasia, DM, diabetes mellitus, EUS, external urethral sphincter, LUT, lower urinary tract, LUTS, LUT symptoms, NO, nitric oxide, USM-C, urethral circular smooth muscle, USM-L, urethral longitudinal smooth muscle