Urodynamic profile of diabetic patients with lower urinary tract symptoms: association of diabetic cystopathy with autonomic and peripheral neuropathy.

OBJECTIVES

To evaluate the association between diabetic cystopathy (DC) and neuropathy (autonomic and peripheral) in patients with diabetes mellitus (DM) presenting with lower urinary tract symptoms (LUTS).

METHODS

Men with DM who presented with bothersome LUTS were enrolled from January 2008 to June 2009. Their demographic and clinical profiles were noted. Multichannel urodynamic studies were performed using the Solar Silver digital urodynamic apparatus. Hand and foot sympathetic skin responses, and motor and sensory nerve-conduction velocity studies were performed using the Meditronic electromyographic/evoked potentials system.

RESULTS

A total of 52 men (mean age 61.3 ± 12.1 years, DM duration 11.0 ± 7.5 years) completed the study protocol. Of these 52 men, abnormal sympathetic skin responses, motor and sensory nerve-conduction velocity studies, and combined neuropathy (all 3 tests abnormal) were noted in 80.7% 57.7%, 57.7%, and 51.9%, respectively. Urodynamic studies showed impaired first sensation (>250 mL), increased capacity (>600 mL), detrusor underactivity, detrusor overactivity, high postvoid residual urine volume (more than one third of capacity), and bladder outlet obstruction (Abrams-Griffiths number >40) in 23.1%, 25.0%, 78.8%, 38.5%, 65.4%, and 28.8% of the men, respectively. Both sensory and motor DC correlated with abnormal motor and sensory nerve-conduction velocity studies (P = .015 and P = .005, respectively). Only motor DC correlated with abnormal sympathetic skin responses (P = .015). The correlations were stronger in the presence of combined neuropathy (sensory DC, P = .005; motor DC, P = .0001).

CONCLUSIONS

Men with DM and LUTS can present with varied urodynamic findings, apart from the classic sensory or motor cystopathy. A large proportion of these patients will have electrophysiologic evidence of neuropathy, and electrophysiologic evidence of neuropathy can moderately predict the presence of cystopathy.