title: Urinary flow disturbance as an early sign of autonomic neuropathy in diabetic children and adolescents.
abstract: OBJECTIVE
  Urinary bladder dysfunction is a frequent complication of diabetes mellitus in adults. The aim of this study is to determine the early disturbances of the detrusor contractility in children, and adolescents with type 1 diabetes.
  
  
  METHODS
  The bladder urine flow parameters were investigated in 37 children with type 1 diabetes, 10/37 with cardiovascular autonomic dysfunction (CAD) voided 482 +/- 128 mils (Group A), 27/37 without CAD voided 258 +/- 52 mils (Group B). From an earlier uroflow screening study 20 healthy children formed group control A, who had voided 488 +/- 94 mils, and another 30 healthy children formed group control B, who had voided 260 +/- 50 mils. The compared groups were matched for voided volume, age, weight, and height. There was no evidence of urinary tract abnormalities in any of the children.
  
  
  RESULTS
  Time to maximum flow was longer in both diabetic groups as compared with controls (P < 0.01), and the acceleration (the ratio of maximum flow and the time to maximum flow) of diabetics was significantly lower (P < 0.01). Bladder emptying was complete in each subject. Bladder wall disturbances were not seen by ultrasound.
  
  
  CONCLUSIONS
  The decreased acceleration of detrusor muscle contraction may be interpreted as an early sign of autonomic neuropathy in children and adolescent with type 1 diabetes, even in patients without CAD. Clinicians may be able to determine autonomic neuropathy by using uroflowmetry that is easy to perform, sensitive, reproducible, and needs only a child's minimal cooperation.
authors.affiliation: Departments of Pediatric Nephrology, Hypertension and Urodynamics, Child Health Center, Borsod County Teaching Hospital, Szentpeteri kapu 72, H-3501 Miskolc, Hungary. lszabo52@t-online.hu
authors.forename: Laszlo
authors.initials: L
authors.lastname: Szabo
authors.forename: Laszlo
authors.initials: L
authors.lastname: Barkai
authors.forename: Bela
authors.initials: B
authors.lastname: Lombay
mesh_terms: D000293:Adolescent; D001342:Autonomic Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000503:physiopathology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009130:Muscle, Smooth / Q000503:physiopathology; D011446:Prospective Studies; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*