Abstract
PurposeTo investigate the relationship between distal symmetric peripheral neuropathy and early stages of autonomic bladder dysfunction in type 2 diabetic women.Materials and MethodsA total of 137 diabetic women with minimal coexisting confounders of voiding dysfunction followed at a diabetes clinic were subject to the following evaluations: current perception threshold (CPT) tests on myelinated and unmyelinated nerves at the big toe for peroneal nerve and middle finger for median nerve, uroflowmetry, post-void residual urine volume, and overactive bladder (OAB) symptom score questionnaire. Patients presenting with voiding difficulty also underwent urodynamic studies and intravesical CPT tests.ResultsBased on the OAB symptom score and urodynamic studies, 19% of diabetic women had the OAB syndrome while 24.8% had unrecognized urodynamic bladder dysfunction (UBD). The OAB group had a significantly greater mean 5 Hz CPT test value at the big toe by comparison to those without OAB. When compared to diabetic women without UBD, those with UBD showed greater mean 5 Hz CPT test values at the middle finger and big toe. The diabetic women categorized as C-fiber hyposensitivity at the middle finger or big toe by using CPT test also had higher odds ratios of UBD. Among diabetic women with UBD, the 5 Hz CPT test values at the big toe and middle finger were significantly associated with intravesical 5 Hz CPT test values.ConclusionsUsing electrophysiological evidence, our study revealed that hyposensitivity of unmyelinated C fiber afferents at the distal extremities is an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. The C fiber dysfunction at the distal extremities seems concurrent with vesical C-fiber neuropathy and may be a sentinel for developing early diabetic bladder dysfunction among female patients.
Highlights
Diabetic bladder dysfunction (DBD) occurs commonly among type 2 diabetic patients, with a reported prevalence between 25% and 87% [1]
Based on the overactive bladder symptom score (OABSS), 26 (19%) diabetic women were classified as having overactive bladder (OAB) syndrome
Based on the definitions provided by International Continence Society (ICS), 34 of these patients presented with urodynamic bladder dysfunction (UBD), including detrusor underactivity (DU) (n = 21), detrusor overactivity (DO) (n = 8), and bladder outlet obstruction (BOO) (n = 5)
Summary
Diabetic bladder dysfunction (DBD) occurs commonly among type 2 diabetic patients, with a reported prevalence between 25% and 87% [1]. During the early (compensated) stages, DBD is usually insidious and inconspicuous. By the time urologists are consulted, DBD has usually reached a late (decompensated) stage with a classic triad of symptoms: reduced bladder sensation, large bladder capacity, and urinary retention. The key feature distinguishing decompensated from compensated DBD is urinary retention brought on by bladder overdistention [2]. The pathophysiology of DBD may be attributed to diabetic polyneuropathy, detrusor myopathy and/or urothelial dysfunction. This multifactorial etiology of DBD leads to a mixed clinical picture of early stages of this disease [4]. The urodynamic findings of early stages DBD in type 2 diabetic women range from detrusor overactivity (DO) to detrusor underactivity (DU), or bladder outlet obstruction (BOO) [2]
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