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Sources of Funding: NorthShore University Health System

Introduction

It has been well established that diabetes mellitus (DM) is a significant risk factor for lower urinary tract symptoms (LUTS). However, data suggests that only approximately 50% of diabetics report bothersome LUTS. We sought to investigate the clinical characteristics that contribute to LUTS in men with diabetes.

Methods

The 2001-2008 National Health and Nutrition Examination Survey (NHANES) database was examined. The records of men age 18-70 years who completed the diabetes form in addition to the prostate and kidney forms were analyzed. LUTS was defined as having one or more of the following symptoms: hesitancy, incomplete emptying, or nocturia >=2). Patients' diabetes status, clinical characteristics and laboratory values were recorded. Statistical analyses was used to compare the frequency of clinical variables among diabetics with and without LUTS.

Results

19202 patients met inclusion criteria including 1157 (6%) with DM. DM patients were significantly more likely to report hesitancy (12.2% vs 9.5%, p=0.012), nocturia (50.1% vs 25.4%, p<.001) but not incomplete emptying (83.6% vs 86.5%, p=.024) compared to non-DM patients. Diabetic men with LUTS were significantly older (63.5 vs 57.5 years, p<.001), more likely to be Caucasian (45.5% vs 28.2%, p=0.002) and more likely to report more medical co-morbidities (32% vs 29.1%, p=<.001) compared to non-DM patients without LUTS. Insulin did not alter the frequency of LUTS among DM patients (p>.05). Diabetic men with retinopathy were significantly more likely to report urinary hesitancy (38.9% vs 21.8%, p<.001), but significantly less likely to report incomplete emptying (21.9% vs 78.1%, p=.004) and >=2 different LUTS (23.1% vs 76.9%, p=.013). There was a similar trend in patients with diabetic nephropathy (defined as significant proteinuria) as shown in Table 1.

Conclusions

Increased age, Caucasian race and more medical co-morbidities are associated with an increased risk of LUTS in men with DM. While diabetics with evidence of end organ damage report an increase in specific urinary symptoms, they report fewer total number of LUTS. This data demonstrates the importance of screening diabetics for LUTS and suggests specific LUTS may be a harbinger of clinical deterioration in these patients.

Funding

NorthShore University Health System