Epidemiologic Investigation & Clinical And Urodynamic Study On Diabetic Cystopathy In Women

BackgroundDiabetes mellitus(DM) is a systemic, metabolic condition characterized by hyperglycemia. An epidemic of diabetic mellitus is under way in both developed and developing countries. According to the survey data from American Diabetes Association(ADA), it affects an estimated 8.3% of the US population. In China, the estimated prevalence of diabetes mellitus is about 11.6%. Diabetes mellitus has become a major public healthcare problem imposing a substantial burden on the economy of China. Diabetic cystopathy(DCP) is one of the common chronic diabetic complications, with an estimated prevalence of 40%-80%. The exact prevalence and pathogenesis of diabetic cystopathy is still unknown and needs to be further investigated. The onset is usually insidious with a slowly progressing course. It’s characterized by decreased bladder sensation, impaired detrusor contractility, impaired upper urinary tract function, and even renal failure. The clinicians usually ignore voiding complaints in patients with diabetes mellitus, usually leading to delayed diagnosis and treatment. Therefore, earyly detection, early diagnosis and early intervention could control the progression of diabetic cystopathy and prevent deterioration, thereby enhancing patients’ health-related quality of life(HRQOL), reducing the social burden of disease and increasing health economic benefits. The various prevalence rates were estimated due to a lack of validated and standardized measures used to diagnose diabetic cystopathy worldwide. Diabetic cystopathy has not been evaluated until now in epidemiological investigation or randomized controlled trials. The purpose of the study is to investigate the epidemiology, clinical and urodynamic characteristics of diabetic cystopathy and the impact of diabetes mellitus on female lower urinary tract dysfunction, shaping the understanding of the etiology and management of diabetic cystopathy, and promoting the development of diagnostic criteria and intervention programs, thereby reducing the burden of disease and increasing health economic benefits. ObjectivesThe purpose of the study was to investigate the prevalence of diabetic cystopathy and the impact on female lower urinary tract dysfunction via a large-scale, multicenter, prospective epidemiological investigation and clinical, urodynamic studies, shaping the understanding of the etiology, pathogenesis, natural disease course, diagnosis and management of diabetic cystopathy. MethodsDue to the indisguishable confounding factor of benign prostatic obstruction(BPO) in men sharing the same lower urinary tract symptoms(LUTS) that can’t be excluded by certain appropriate testing easily, we just included female cases with diabetic cystopathy after excluding other causes of lower urinary tract dysfunctionBased on the latest research of Neurourology & Urodynamics, we prospectively collected data of 2,460 consecutive diabetic women, between 1 January 2010 and 1 March 2015, from more than 26 healthcare and medical sites in Dujiangyan District, China, including the inpatient departments and outpatient clinics of urology, endocrinology, geriatrics and nephrology in primary, secondary and tertiary referral hospitals, rural healthcare stations, and nursing homes. All the referred cases were evaluated with direct medical, surgical, obstetric, and gynecological history inquiry, 3-day micturition diary, diabetes treatment and diabetic complications, targeted physical examinations, fasting blood glucose(FPG), glycosylated hemoglobin(Hb A1c), blood chemistries, urinalysis, urodynamic studies(UDS), urinary tract ultrasonography, and videourodynamics(VUDS) or cystography if necessary.Data on clinical manifestations and urodynamic parameters were evaluated and collected in the enrolled patients, and the prevalence of diabetic cystopathy was investigated using statistics. ResultsTotally 2460 consecutive women with diabetic mellitus met the inclusion and exclusion criteria, and were prospectively enrolled. About 91.7% of diabetic women(2255 cases) complained of lower urinary tract symptoms and 88.0%(2166 cases) had positive urodynamic findings, ranging from an overactive bladder(OAB) to a hyposensate and poorly contractile bladder in the study.About 1521 diabetic women(61.8%) presented with storage symptoms, 1351 cases of which had involuntary detrusor contraction on urodynamics. Seven hundred and thirty-four patients(29.9%) presented with voiding symptoms, 196 cases of which had detrusor areflexia. About 1177 cases had impaired detrusor contractility.Among the 1373 patients with impaired detrusor contractility or detrusor areflexia, the mean first sensation of filling(FSF) was 238.1ml(range, 100-456), with a mean maximum cystometric capacity(MCC) of 624ml(range, 320-1534), mean maximum flow rate(MFR) of 9.6 ml/s(range, 0-25), mean detrusor pressure at maximum flow rate(Pdet Qmax) of 32.4cm H2O(range, 0-88), and mean post-void residual(PVR) of 323ml(range, 0-1230).Fifty-six of 196 patients with detrusor areflexia had impaired renal function in blood chemistry tests, and massive bilateral ureterohydronephrosis in ultrasonography and ―Christmas tree‖ shaped bladder in videourodynamic studies.Diabetic cystopathy is having its modern definition and it is a progressive condition with a spectrum of clinical symptoms and urodynamic findings, ranging from an overactive bladder to a poorly contractile bladder.According to the modern definition of diabetic cystopathy, on the whole, 95% diabetic women had diabetic cystopathy in Dujiangyan District, China. ConclusionsDiabetes mellitus alters voiding patterns significantly, causing various lower urinary tract symptoms in a significant proportion of diabetic women population.Diabetic cystopathy is having its modern definition and it is a progressive condition with a spectrum of clinical symptoms and urodynamic findings, ranging from an OAB to a poorly contractile bladder.The prevalence of diabetic cystopathy is very high(95%) in Dujiangyan District, China.Fasting plasm glucose and glycosylated hemoglobin levels are significantly higher in diabetic women with lower urinary tract symptoms and abnormal urodynamic changes. No. of live birth in diabetic women seems not to be impact factors. The exact impact of diabetes duration on lower urinary tract function needs further investigation.