Hidden Bladder Dysfunction in Well-Controlled Diabetes: A Urodynamic Study of Men With Lower Urinary Tract Symptoms.

OBJECTIVES

To investigate in detail whether well-controlled diabetes mellitus (DM) without neuropathy, retinopathy, or nephropathy affects lower urinary tract symptoms (LUTS) and function.

METHODS

Of treatment-naïve men with LUTS, those with DM but with good glycemic control (hemoglobin A1c [HbA1c] < 7.0%) and no obvious DM-related complications were included in the DM group. The patients matched to the DM group for backgrounds that might affect lower urinary tract function, including age and prostate volume, were set as the non-DM group, and urodynamic parameters were compared between the groups. In addition, clinical factors associated with bladder dysfunction were examined within the DM group.

RESULTS

A total of 139 men were included in each group (DM group: mean age 73.3 years, prostate volume 38.8 mL, HbA1c 6.6%, DM duration 122 months). Although bladder outlet obstruction index did not differ significantly between the two groups, bladder voiding efficiency, maximum flow rate, and bladder contractility index were significantly lower in the DM group. Notably, the proportion of patients with detrusor underactivity (DU) was significantly higher in the DM group (41.7% vs. 25.9%, p = 0.005). Furthermore, in the DM group, a longer duration of DM and smaller prostate size were significant factors associated with the development of DU.

CONCLUSIONS

A significant decrease in detrusor contractility was observed in men with DM even with good glucose control. Among men with LUTS, even with well-controlled DM, those with a longer disease duration and smaller prostate size are at a high risk of LUTS due to bladder dysfunction.

TRIAL REGISTRATION: UMIN000056036.