Abstract: PD39-03
Sources of Funding: None

Introduction

We retrospectively analyzed urodynamic data in patients with diabetic mellitus (DM) to assess diabetic cystopathy.

Methods

Subjects included male DM patients who had a pressure flow study (PFS) in our institution from April 2005 to October 2016. Patients with prostate volume < 30 ml; no previous history of neurological disorder, prostate cancer, or pelvic surgery; no current urinary medication; and bladder outlet obstruction index < 40 were included. Bladder dysfunction was categorized into the following urodynamic patterns: (a) normal: bladder contractility index (BCI) > 100 without detrusor overactivity (DO); (b) DO: BCI > 100 with DO; (c) detrusor hyperreflexia/impaired contractility (DHIC): BCI ≤ 100 with DO; and (d) detrusor underactivity (DU): BCI ≤ 100 without DO. Urodynamic patterns were evaluated based on the presence of diabetic retinopathy (DR) and nephropathy (DN), which tend to be dependent on DM duration. Linear and multiple regression analyses were performed to investigate the relationship between clinical factors and urodynamic parameters.

Results

Fifty patients (mean age 66 ± 8 years, DM duration 7 ±1 years) were enrolled. Twenty patients without DR or DN showed 5 normal (25%), 4 DO (20%), 4 DHIC (20%), and 7 DU (35%) patterns on PFS; 17 patients with DR but no DN showed 2 normal (11.7%), 9 DHIC (52.9%), and 6 DU (35.2%) patterns; 13 patients with DR and DN showed 3 normal (23.0%), 3 DHIC (23.0%), and 7 DU (53.8%) patterns. Univariate analysis indicated that DM duration, hemoglobin A1c (HbA1c) level, and DR were significantly negatively correlated with BCI (r² = 0.13, p = 0.02; r² = 0.11, p = 0.03; r² = 0.28, p = 0.001, respectively). Multivariate analysis also revealed that DM duration, HbA1c level, and DR were significantly negatively correlated with BCI (r² = 0.44, p = 0.04, p = 0.02, and p = 0.02, respectively). Furthermore, univariate and multivariate analyses showed that first desire volume (FDV) was significantly positively correlated with post-void residual (PVR) urine (r² = 0.49, p < 0.001 and r² = 0.63, p < 0.001) and voiding efficiency (r² = 0.14, p < 0.001 and r² = 0.63, p < 0.001). In addition, maximum cystometric capacity (MCC) was significantly positively correlated with PVR (r² = 0.28, p < 0.001). However, FDV and MCC were not significantly associated with other urodynamic parameters, including BCI.

Conclusions

Our study indicated that DM patients had diverse progressive bladder dysfunction patterns. Moreover, impaired bladder sensation increased PVR independent of detrusor contractility.

Funding

None