Women With Type 2 Diabetes: Understanding Bladder Dysfunction

September 23, 2007 – 8:23 pm | posted in Urology / Nephrology

UroToday.com - Presented Monday, 03 September 2007 at the 29th Congress of the Societe International d’Urologie - SIU 2007 - Optimizing Clinical Outcomes in Prostate and Renal Cell Carcinomas - The Second Annual Symposium on Advanced GU Malignancy - Palais des Congres de Paris, France

Introduction: Prior literature suggests that among older women with diabetes, a flaccid, hypotonic, or atonic bladder condition termed diabetic cystopathy is common. However, most studies were limited in that they were conducted in patients attending specialty clinics and did not differentiate women and men or type 1 and type 2 diabetes. To evaluate changes in bladder function in women with type II diabetes, we assessed a well characterized populationbased cohort with urodynamic testing.

Methods: Of the 400 women with type 2 diabetes in the Reproductive Risks for Incontinence Study at Kaiser (RRISK), 48 women (mean age 62.1 years), from a consecutive sample, volunteered to undergo urodynamic testing. Measurements of urinary incontinence (UI) were obtained via self-reported questionnaires, in person interviews, physical examination and standard urodynamic evaluation. Extensive diabetes measures including duration, treatment, glycemic control, complications of diabetes, and laboratory data were also obtained. Incontinence severity was assessed by the Sandvik Severity Score.

Results: None of the women had bladder cystopathy, 38% had weekly UI, and nearly a quarter meet the criteria for severe UI. Half of the women reported mild lower urinary tract symptoms (LUTS), (AUA Symptom score › 7), 42% moderate, and 8% severe LUTS. Nearly three quarters (73%) were using insulin and overall had a mean hemoglobin A1C of 7.5 (±1.3). Retinopathy was present in 11% of the women, neuropathy in 54%. The mean bladder capacity was 337ml and only 2 women had a capacity < 550cc. In looking at evidence of abnormal bladder sensation, 16% of women reported first desire to void at less than 100cc and 24% reported first desire at greater than 250cc. The average post void residual (PVR) was 61.8cc, and 81% had PVR <100. The mean average flow rate was 10.2 + 6.0 ml/sec. There was only evidence of detrusor overactivity in 3 women, and urge urinary incontinence was only diagnosed in 1 woman.

Conclusions: From urodynamic testing, our cohort demonstrated early impairment of bladder sensation and detrusor contractility. Diabetic cystopathy does not appear to comprise the majority of bladder dysfunction, but rather a relatively uncommon end organ effect of diabetes.

Authors: Mehdizadeh JL, Deng DY, Sweeting WC, Mallipeddi P, Creasman JM, Brown JS

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