Urinary Bladder Disturbances in Diabetics: I. A Comparative Study of Male Diabetics and Controls Aged between 20 and 50 Years

Abstract

In order to establish the frequency of urinary bladder disturbances in diabetics and to attempt to obtain support for the view that these bladder disturbances are neurogenic, 30 male diabetics' clinical data were analysed and correlated to the findings of cystometry, micturition urethrocystography and pelvic floor electromyography. A control series of 25 healthy men was studied with the same methods. 5 of 30 diabetics had micturition difficulties. Impotence andlor ejaculatory disturbances were present in 8 cases.On cystometry, some 50 per cent of the diabetics had a bladder capacity in excess of 600 ml and a hypotonic cystometric curve. Micturition urethrocystography demonstrated "large bladders" in roughly 50 per cent of the diabetics, but also a number of instances of faulty widening of the internal sphincter, hypotonic bladder shape, or signs of infection. MicturLtion urethrocystography demonstrated pathologic findings in altogether 65 per cent of the diabetics.Electromyography showed an increased potential duration in the striated urethral sphincter, the striated anal sphincter and the levator ani. No signs of peripheral neuronal damage or myopathy were detected.No fully proven correlation between the bladder disturbances and the duration and other manifestations of the disease was demonstrable. However, 10 of seventeen patients with "large bladders" had signs of peripheral neuropathy, while 7 had no such signs. Vascular damage was present in 7 of the first group and in 5 of the second group.The present investigation affords no evidence that the urinary bladder disturbances in the diabetics resulted from neurogenic damage. Scand J Urol Nephrol IScand J Urol Nephrol Downloaded from informahealthcare.com by University of Toronto on 01/03/15 For personal use only. Scand J Urol Nephrol I Scand J Urol Nephrol Downloaded from informahealthcare.com by University of Toronto on 01/03/15 For personal use only. Gill, R D. 1936. The diabetic (cord) bladder. J Urol 36, 730.

Bladder dysfunction and neuropathy in diabetes

“…Diabetic autonomic neuropathy affecting the gastrointestinal tract and vascular reflexes has also been reported [21,22,23,24,25]. Earlier studies have also shown the frequency of abnormal bladder function in diabetic patients, based on clinical, radiological, endoscopic and manometric assessments [26,3,27,5,6,8]. In the present study measurement of urine flow rates and of urethral pressure profiles could distinguish mechanical outflow tract obstruction from a bladder neuropathy secondary to diabetes, so that any abnormalities due to the coexistence of prostatic hypertrophy in elderly male diabetics could be set aside.…”

“…At first, bladder involvement was considered to be a late manifestation of poorly controlled diabetes [1,2,3,4]. However, recent studies with improved techniques have shown not only a high incidence of both autonomic and peripheral neuropathy, even at the time of the initial diagnosis [5,6,7,8,9,10], but also that the condition may at times be asymptomatic [11,12,13]. Therefore, in an effort to define the incidence and clinical features of diabetic neuropathy, we have carried out a combined urodynamic/electrophysiological study on some of our diabetic patients, choosing some with evident neuropathic features, some presenting with diabetic retinopathy problems, some with urinary frequency without obvious cause as well as some on routine treatment and some newly diagnosed.…”

The effect of streptozotocin‐induced diabetes on cholinergic motor transmission in the rat urinary bladder

“…The finding that the EFS-evoked cholinergic response generated significantly greater tension in diabetic detrusor compared to the control is unexpected, as well as puzzling, since clinical diabetes mellitus is frequently associated with a 'failing' detrusor function (Fagerberg et al, 1967;Kahan et al, 1970;Buck et al, 1974;Bradley, 1980;Ellenberg, 1980). In theory, the enhanced nerve-mediated cholinergic response of the diabetic detrusor must have originated in either an augmented sensitivity of the detrusor to released ACh, or to an augmented ACh release, or to a combination of both of these factors.…”

Vegetative Symptome bei diabetischen Polyneuropathien

“…So haben z. B. fast alle Diabetiker mit sensiblen distalen PNP-Zeichen Blasenfunktionsstörungen (119,141), und alle Patienten mit einer diabetischen Diarrhö oder mit einem trophischen Ulkus sowohl sensible distale PNP-Zeichen als auch kardiale Innervationsstörungen (307). Da sich für die diabetologische Praxis aus dieser Tatsache konkrete diagnostische (z.…”