Electrophysiologic tests of bladder innervation as indicators of autonomic neuropathy in diabetes mellitus

Abstract

AbstractElectrophysiologic tests of bladder innervation are considered to be sensitive indicators 2of impaired bladder function in patients with diabetes mellitus (DM). A question arose as to whether these tests could also be considered early indicators of neuropathic visceral involvement. As diabetic neuropathy is a condition involving several systems, it seemed worthwhile to investigate subjects with impaired glucose tolerance (IGT) and patients with DM with several diagnostic tools: sacral evoked responses (SERs), urodynamics, peripheral nerve conduction studies, and cardiovascular autonomic function tests.In the IGT group SERs were found to be within normal limits in all subjects, whereas cardiac parasympathetic function tests were frequently found to be altered, suggesting autonomic involvement even in the presymptomatic period of the disease. In the DM group prolonged latencies of SERs were not constantly associated with urodynamic bladder dysfunctions, suggesting a difference between neurons involved in SERs and neurons actually involved in pelvic parasympathetic innervation of the urinary bladder. Furthermore the alterations of the single diagnostic tests of autonomic neuropathy appeared to be scattered among the patients without any evident relationship between one another or with the duration and the type of the disease. Results do not suggest that electrophysiologic tests of bladder innervation are early indicators of widespread autonomic neuropathic involvement.