Diabetic bladder dysfunction: current translational knowledge.
OBJECTIVE
Diabetes mellitus, a metabolic disorder caused by an absolute or relative deficiency of insulin, is a debilitating and costly disease with multiple serious complications. Lower urinary tract complications are among the most common complications of diabetes mellitus. The most common, bothersome lower urinary tract complication of diabetes mellitus is diabetic cystopathy or diabetic bladder dysfunction. We reviewed the current translational knowledge of diabetic bladder dysfunction.


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 the future direction of research.


RESULTS
Despite traditional recognition of diabetic bladder dysfunction as a voiding problem characterized by poor emptying and overflow incontinence, recent clinical and experimental evidence indicate storage problems such as urgency and urge incontinence in diabetes mellitus cases. Recent experimental evidence from studies of diabetic bladder dysfunction in small animal models of diabetes mellitus show a temporal effect on diabetic bladder dysfunction. Early phase diabetes mellitus causes compensated bladder function and the late phase causes decompensated bladder function. The temporal theory could plausibly provide the scientific road map to correlate clinical and experimental findings, and identify the role of mechanisms such as polyuria, hyperglycemia, oxidative stress, autonomic neuropathy and decompensation of the bladder contractile apparatus in the creation of clinical and experimental manifestations of diabetic bladder dysfunction.


CONCLUSIONS
Diabetic bladder dysfunction includes time dependent manifestations of storage and emptying problems. Identifying mechanistic pathways would lead to the identification of therapeutic intervention.
Department of Urology, Case Western Reserve University, Cleveland, Ohio, USA. firouz.daneshgari@case.edu
Firouz
F
Daneshgari
Guiming
G
Liu
Lori
L
Birder
Ann T
AT
Hanna-Mitchell
Samuel
S
Chacko
D000975:Antioxidants / Q000494:pharmacology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D006801:Humans; D015227:Lipid Peroxidation; D018384:Oxidative Stress; D012307:Risk Factors; D013997:Time Factors; D001745:Urinary Bladder Diseases / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control
D000975:Antioxidants