Correlation of Clinical and Urodynamic Results with the Duration of Diabetic Cystopathy

Park, Sung Tae; Lee, Jeong Gu

Abstract

Classical urodynamic findings associated with diabetes mellitus (DM) has been described as decreased bladder sensation, increased bladder capacity and impaired detrusor contractility. However, various urodynamic findings may be found according to the duration, treatment and concomitant complications of disease. In this study, clinical and urodynamic results of 30 patients with diabetic cystopathy(DCP) were retrospectively analyzed to ascertain the correlation of the duration with specific types of voiding dysfunction associated with DM. Patients with DCP were classified either as irritative symptom group (frequency, nocturia and urgency) or obstructive symptom group (hesitancy, abdominal strain, urinary retention and decreased stream). Mean duration until the onset of voiding symptoms after diagnosis of diabetes were 5.3 years in irritative and, 10 years in obstructive symptom group. Urodynamic findings were classified as impaired detrusor contractility with hyposensitivity (ICHS), detrusor hyperreflexia with impaired contractility(DHIC), detrusor hyperreflexia(DH), and normal. Of the 30 patients, 15(50%) had ICHS, 8(27%) had DH, 4(13%) had DHIC and 3(10%) had normal findings. Mean duration until the onset of voiding symptoms after diagnosis of diabetes were 10.5 years in ICHS, 9.5 years in DHIC, 6.8 years in DH and 2.7 years in normal findings. Of the 10 patients with irritative voiding symptoms, DH was noted in 6 cases(60 %); whereas ICHS was the most common(15 cases) abnormality found among 20 patients with obstructive symptoms. Of the 15 patients showed ICHS, 12 patients(75%) were treated with insulin; whereas only 3 were treated either with hypoglycemic agent or diet alone. These results suggests that shorter the duration of DM, irritative symptoms with DH were predominant; whereas longer the duration of DM, obstructive voiding symptoms with ICHS were predominantly observed. It is also suggested. that the incidence of ICHS were more frequent in the patients with worse degree of DM treated with insulin. Conclusively, various types of urodynamic finding are present in the patients with diabetic cystopathy in addition to the classical DCP(ICHS), which was noted predominantly in the patients with longer duration of diabetes and treated by insulin.