Abstract
Diabetes mellitus (DM) is an independent risk factor for overactive bladder (OAB). The pathophysiology of DM-associated OAB is multifactorial and time-dependent. Diabetic bladder dysfunction is highly associated with diabetic complications, mainly including diabetic neuropathy and atherosclerosis. Chronic systemic inflammation and bladder urothelial inflammation may contribute to the onset of OAB. Intravesical botulinum toxin A (BoNT-A) injection has proved to be a successful treatment for idiopathic and neurogenic OAB. BoNT-A can inhibit the efferent pathways of the bladder as well as the chronic inflammation and hypersensitivity via the afferent pathways. We conducted a review of the published literature in Pubmed using a combination of two keywords, namely “botulinum toxin A” (BoNT-A) and “overactive bladder”, with or without the additional keywords “detrusor overactivity”, “diabetes mellitus”, “inflammation”, and “urodynamic study”. We also reviewed the experience of our research teams, who have published several studies of the association between DM and OAB. Since limited data support the effectiveness and safety of BoNT-A for treating patients with DM-associated OAB, a comprehensive evaluation of diabetic complications and urodynamic study is needed before treatment. In the future, it is imperative to explore the clinical characteristics and inflammatory biomarkers of diabetes as determining predictors of the treatment efficacy.
Highlights
Overactive bladder (OAB) and diabetes mellitus (DM) are common health threats and both increase in incidence and prevalence with advancing age
We reviewed the experience of our research teams, who have published several studies of the association between DM and overactive bladder (OAB)
Because of the very different presentations of diabetic bladder dysfunction, we suggest patients with DM-associated OAB undergo a comprehensive evaluation for possible diabetic complications and urodynamic studies before treatment of refractory DM-associated OAB
Summary
Overactive bladder (OAB) and diabetes mellitus (DM) are common health threats and both increase in incidence and prevalence with advancing age. Regarding OAB management, a study of 36,560 OAB patients in the US found that patients with DM are more persistent and adherent to OAB medications and have higher odds of filling a second medication prescription than patients without DM [6]. These factors may imply that DM is an important risk factor of OAB, but conventional oral medication is usually not as effective for OAB patients with DM. We aimed to clarify the role of BoNT-A treatment in these patients
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