1960 LOWER URINARY TRACT DYSFUNCTION AMONG ADULT WOMEN WITH DIABETIC MELLITUS

Abstract

INTRODUCTION AND OBJECTIVES: Lower Urinary Tract Dysfunction (LUTD) is frequent among diabetic women. Our aim was to further evaluate LUTD in diabetic females, especially in regard to diabetic bladder dysfunction (DBD). METHODS: During three years study period, females with or without diabetic mellitus (DM) presenting to urology clinics were enrolled and evaluated by several validated instruments including American Urological Association Symptom Index (AUA-SI), Pelvic Floor Disorder Screening Questionnaire, Female Sexual Function Index, DM Screening Questionnaire, and uroflowmetry with postvoid residual urine volume measurement. Urinalysis and hemoglobin A1c (HbA1c) were also assessed. Overactive bladder (OAB) was defined as voiding frequency of 8 times/day. DBD was defined as a PVR 100 ml or a Qmax 12 ml/second or a bladder voiding efficiency 75% with a 50 PVR 100 ml. The data were reviewed and analyzed as to having various types of LUTD or DBD. Logistic regression model was also fitted with age, race, mean HbA1c, DM duration, UTI, total AUA-SI score, and pelvic floor disorders as the predictors of bladder dysfunction. RESULTS: 99 females with type I (23%) or II (77%) DM and 22 non-DM women were recruited. The mean age of patients with and without DM was 56.1 13.1 and 52.4 9.9 years, respectively. The mean duration of diabetes was 14.2 years and mean HbA1c was 7.9. Regarding LUTD, Mean total AUA-SI score of DM females was significantly higher than the controls (9.4 6.7 vs 5.7 4.9). Statistically significance difference was also achieved for the symptoms of incomplete emptying (p 0.03), weak stream (p 0.03), OAB (p 0.02) and sexual dysfunction (p 0.002) between DM and non-DM females. OAB was more frequently observed in type II than type I patients (43% vs 9%, p 0.05). Thirty-three (33.3%) patients were stratified as having DBD. These women had a significantly greater mean AUA-SI score (11.8 6.4 vs 8.1 6.5) than those without DBD. Further, a significantly greater percentage of DBD females had symptoms indicating urge incontinence (63.6% vs 39.4%, p 0.02), OAB (51.5% vs 27.3%, p 0.02) and fecal incontinence (33.3% vs 13.6%, p 0.02) compared to non-DBD patients. After adjustment for mentioned confounders, increasing in DM duration (OR: 1.1, 95% CI: 1.002-1.152) and having OAB (OR: 8.1, 95% CI: 1.07-6.45), were found to increase the risk of developing DBD. CONCLUSIONS: Our findings show that diabetic women have an increased risk of LUTD including OAB, weak urinary stream, incomplete bladder emptying and sexual dysfunction. Furthermore, DM duration and presence of OAB could be considered as risk factors for developing DBD.