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Diabetic Bladder Dysfunction: Current Translational Knowledge #MMPMID19846137
Daneshgari F; Liu G; Birder L; Hanna-Mitchell AT; Chacko S
J Urol 2009[Dec]; 182 (6 0): S18-26 PMID19846137show ga
Purpose: Diabetes mellitus (DM) is a metabolic disorder caused by an absolute or relative deficiency of insulin, a debilitating and costly disease with multiple serious complications. Lower urinary tract (LUT) complications are among the most common complications of DM. The most common and bothersome LUT complication of DM is diabetic cystopathy, or diabetic bladder dysfunction (DBD). We reviewed the current translational knowledge of DBD. Materials and Methods: We performed a search of the English literature through PUBMED. The key words used were ?diabetes? and ?bladder dysfunction? or ?cystopathy?. Our data and perspective are provided for consideration of future direction of research. Results: Despite traditional recognition of DBD, as a voiding problem, characterized by poor emptying and overflow incontinence, recent clinical and experimental evidence indicate a presence of storage problems such as urgency, and urge incontinence in DM. Recent experimental evidence from studies of DBD on small animal models of DM, indicate the presence of a temporal effect on DBD: Early phase of DM causes compensated bladder function; and late phase of DM causes decompensated bladder function. The ?temporal theory? could plausibly provide the scientific road map for correlation between clinical and experimental findings as well as identification of role of mechanisms such as polyuria, hyperglycemia, oxidative stress, autonomic neuropathy and decompensation of contractile apparatus of the bladder in creation of clinical and experimental manifestations of the DBD. Conclusions: DBD includes time-dependent manifestations of storage and emptying problems. Identification of mechanistic pathways would lead us to identification of therapeutic intervention.