Urodynamic Evaluation in Diabetic Patients with Prostate Enlargement and Lower Urinary Tract Symptoms

Abstract

Introduction: Lower urinary tract symptoms (LUTS) are common in men over 50 years of age due to prostate enlargement. Diabetes mellitus is also more prevalent in this group. LUTS may result from bladder outlet obstruction (BOO) secondary to prostate enlargement or bladder dysfunction secondary to diabetes or even from a combination of both. Objectives: The objective of this study was to determine the prevalence of BOO and other urodynamic abnormalities in diabetic patients with LUTS and enlarged prostate. A secondary objective was to assess the predictive value of non-invasive tests for BOO diagnosis in this group of patients. Patients and Methods: 50 consecutive diabetic patients with enlarged prostate and LUTS were evaluated by the International Prostate Symptom Score (IPSS), ultrasonography and urodynamics. BOO diagnosis was based on pressure/flow measurements according to the International Continence Society’s standards. Results: Of the 50 patients in the study, 23 (46%) had BOO. There was no correlation between the IPSS, uroflowmetry, post-voiding residual urine or prostate volume and the presence of BOO (p > 0.05). Conclusions: There is a relatively low prevalence of BOO in diabetic patients with prostate enlargement and LUTS. Non-invasive tests did not allow the identification of these subjects. Only urodynamic evaluation is able to determine symptom etiology.

Clinical guidelines for male lower urinary tract symptoms associated with non-neurogenic overactive bladder

“…Only urodynamic evaluation is able to determine symptom etiology. 50 6. Urodynamic study for OAB in male LUTS LUTS in men is highly prevalent and storage LUTS is more prevalent than voiding or postmicturition symptoms.…”

Management of Lower Urinary Tract Dysfunction in Patients with Neurological Disorders

“…In addition, large proportions of men with diabetes and LUTS have electrophysiological evidence of neuropathy, and thus may present with varied urodynamic findings [40]. Furthermore, most diabetic patients with LUTS have reported a lower incidence of bladder outlet obstruction (26 to 36%), even though they have prostate enlargement (46%) [40,41]. In these patients, the etiology of their symptoms is only determined by urodynamic evaluation and not by noninvasive tests such as the International Prostate Symptom Score, free uroflowmetry, or PVR, which have low sensitivity and specificity for diagnosis of bladder outlet obstruction [41].…”

“…Furthermore, most diabetic patients with LUTS have reported a lower incidence of bladder outlet obstruction (26 to 36%), even though they have prostate enlargement (46%) [40,41]. In these patients, the etiology of their symptoms is only determined by urodynamic evaluation and not by noninvasive tests such as the International Prostate Symptom Score, free uroflowmetry, or PVR, which have low sensitivity and specificity for diagnosis of bladder outlet obstruction [41]. Therefore, the performance of systematic urodynamic evaluation has been suggested to be a prerequisite for making critical decisions and especially before surgical management in diabetic patients with LUTS [40,41].…”

Specific features of urogenital disorders in patents with diabetes mellitus

“…Некоторые исследователи полагают, что СД может быть фактором риска развития и прогрессирования ДГПЖ, вследствие того, что как диабетическая нейропатия, так и ДГПЖ способны инициировать дисфункцию мочевого пузыря, что вызывает трудности в определении степени влияния СД и/или ДГПЖ на развитие нарушений мочеиспускания у этих пациентов [71]. Следует отметить, что по данным обследования 50 больных с увеличенной предстательной железой, симптомами поражения нижних мочевых путей и СД только у 46% выявлялась инфравезикальная обструкция [72].…”