Diabetic Neurogenic Vesical Dysfunction

Ellenberg, Max

doi:10.1001/archinte.1966.03870090032006

Cited by 38 publications

(18 citation statements)

References 18 publications

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“…The onset of symptoms from a neurogenic bladder is insidious, and the patient may remain asymptomatic. Eventually, symptoms of an atonic bladder appear, and in advanced cases are accompanied by urinary tract infections [13]. In our study, asymptomatic diabetic children and adolescents had early abnormalities in bladder function independent of impaired cardiovascular reflexes, however, the degree of bladder dysfunction was more pronounced in patients with than without CAD.…”

Section: Discussionmentioning

confidence: 40%

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

Barkai

Szabo

1993

Eur J Pediatr

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The aim of this study was to assess the relationship between bladder dysfunction and impaired cardiovascular reflexes in diabetic children with no clinical symptoms of autonomic neuropathy. After 15 ml/kg of water intake, the time to first sensation to void, the voiding volume, the voiding time, the average and maximum urinary flows, and the time to maximum urinary flow were estimated by sonography and uroflowmetry in diabetic children with and without cardiovascular autonomic dysfunction (CAD), and in a healthy control group. The three groups of children were matched for age, weight and height. CAD was considered to be present if the results of cardiovascular tests were more than 2SD from the mean of healthy controls. Diabetic children with and without CAD had increased time to first sensation to void, voiding volume, and average urinary flow when compared with healthy children. Voiding volume and average and maximum urinary flows were higher in diabetic children with CAD than in those without CAD. Diabetic children with CAD had also a higher maximum urinary flow than diabetic children without CAD and healthy children. Diabetic children with CAD had a longer diabetes duration and a higher mean fructosamine level during the preceding 3 years than those without CAD. These findings suggest that diabetic children may have diminished sensation of bladder filling independent of impaired cardiovascular reflexes, however, the degree of bladder dysfunction parallels with CAD, both depending on diabetes duration and long-term glycaemic control.

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Section: Discussionmentioning

confidence: 40%

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

Barkai

Szabo

1993

Eur J Pediatr

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“…Erectile impotence in male diabetics is a distressingly frequent complication (Rubin and Babbott, 1958;Keen, 1959;Sprague, 1963;Ellenberg, 1971;Jadzinsky et al, 1973;Melman et al, 1978, occurring in 50% or more of all diabetic men. Retrograde ejaculation has also been noted in diabetic men (Ellenberg, 1966).…”

Section: Diabetic Autonomic Neuropathy and Penilementioning

confidence: 95%

Noradrenergic innervation of the penis in control and streptozotocin‐diabetic rats: Evidence of autonomic neuropathy

Felten

Melman

1983

Anat. Rec.

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The noradrenergic sympathetic innervation of the penis of control and 4-month streptozotocin-diabetic rats was examined with the glyoxylic acid histofluorescence method. Noradrenergic varicosities were found in the corpora cavernosa in a dense subtunical plexus and in the perisinusoidal and trabecular regions of the erectile tissue, in the corpus spongiosum in perisinusoidal tissue, around large arteries and veins, and around small tortuous arterioles and small draining veins of the corpora cavernosa and spongiosum. Noradrenergic varicosities were diminished in number and fluorescent intensity in all regions of the penis of diabetic rats compared with controls. The subtunical plexus was absent, perisinusoidal and trabecular varicosities were sparse, and only occasional intermittent, discontinuous, dull fluorescent fibers or plexuses were found around the vessels. Quantitation with high-performance liquid chromatography revealed a significant reduction of norepinephrine in the penis of diabetic rats compared with controls. The present study suggests that long-term streptozotocin diabetes in the rat is accompanied by sympathetic autonomic neuropathy of the penis that seems to parallel changes in the noradrenergic content of penile corpora of men with diabetes and erectile impotence. The streptozotocin-diabetic rat merits further study to explore the relationship between noradrenergic innervation of the penis and erectile tissue.

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“…Several studies have correlated the presence of abnormalities in the bladder with signs of peripheral neuropathy [4,5,17]. In addition, clinical investigations of bladder innervation and function have led to the conclusion that bladder dysfunction is a manifestation of autonomic neuropathy in diabetes mellitus [3,7,15,20]. In particular, a defect in the sensory nerves of the bladder has been implicated as the cause of bladder distension in diabetic patients, whilst incomplete bladder emptying occurs as a result of impaired detrusor activity [5,6,16,36].…”

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confidence: 99%

Rat bladder in the early stages of streptozotocin-induced diabetes: adrenergic and cholinergic innervation

et al. 1984

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Summary. The adrenergic and cholinergic innervation of the bladder was studied in streptozotocin-diabetic rats. The presence of hypertrophy and distension in the 'diabetic' bladders necessitates care in assessing changes occurring in the nerves, factors which are also relevant to clinical histochemical studies. Biochemical assays of cholinergic enzymes revealed decreased activities per g wet weight tissue. However, the total activities of choline acetyltransferase and acetylcholinesterase per whole bladder were significantly increased after 2 weeks of diabetes with greater changes by 8 weeks. Total dopamine levels per bladder were significantly higher than in control rats in the 2-week but not the 8-week group of animals; this may indicate an initial increase in adrenergic nerve activity. There was no impairment in the ability of the detrusor muscle to respond to noradrenaline, acetylcholine or to cholinergic nerve stimulation. Shortly after induction of diabetes streptozotocin-treated rats display polyuria. It is proposed that the activity of the bladder is therefore stimulated to allow greater volumes of urine to be passed. The results are discussed in relation to human diabetes mellitus where clinical studies have implicated a neuropathic origin to bladder dysfunction.Key words: Bladder, diabetic rats, adrenergic nerves, cholinergic nerves, polyuria, neuropathy.Clinical studies on bladder function in patients suffering from diabetes mellitus have reported that an early indication of dysfunction is increased bladder capacity and size, the incidence of such abnormalities has been reported as being as high as 87% in a group of juvenileonset diabetic patients [21]. Later stages are associated with atony of the bladder and urinary retention [16,21,29], and recent literature reveals that the clinical treatment of these symptoms is still under discussion [19,32, 39]. Several studies have correlated the presence of abnormalities in the bladder with signs of peripheral neuropathy [4,5,17]. In addition, clinical investigations of bladder innervation and function have led to the conclusion that bladder dysfunction is a manifestation of autonomic neuropathy in diabetes mellitus [3,7,15,20]. In particular, a defect in the sensory nerves of the bladder has been implicated as the cause of bladder distension in diabetic patients, whilst incomplete bladder emptying occurs as a result of impaired detrusor activity [5,6,16,36]. Histochemical studies on diabetic patients [20] and the diabetic Chinese hamster [10] have revealed reduced staining for acetylcholinesterase in the 'diabetic' bladder, and consequently it has been suggested that an alteration in the cholinergic innervation of the bladder may be one factor involved in bladder dysfunction.In the present investigation, bladder dysfunction was studied in the early stages of streptozotocininduced diabetes in rats, an animal model of juvenileonset diabetes. Distension and hypertrophy of the bladder occurred rapidly after the onset of diabetes, and the adrenergic and choliner...

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Diabetic Neurogenic Vesical Dysfunction

Cited by 38 publications

References 18 publications

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy

Noradrenergic innervation of the penis in control and streptozotocin‐diabetic rats: Evidence of autonomic neuropathy

Rat bladder in the early stages of streptozotocin-induced diabetes: adrenergic and cholinergic innervation

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