JDM  Vol.4 No.1 , February 2014
Diabetic cystopathy in children and adolescents with Type 1 diabetes mellitus
Abstract: Background: Urinary bladder dysfunction is a major complication of diabetes mellitus and its mechanism has been attributed to autonomic and/or peripheral neuropathy. Objectives: Evaluation of diabetes mellitus and neuropathy effect on the urinary bladder dynamics in children and adolescents with Type 1 diabetes mellitus. Patients and Methods: The study included 80 children and adolescents with Type 1 diabetes for at least 5 years; 60 patients were with manifestations of autonomic and/or peripheral neuropathy and 20 patients were free of either. We assessed both groups for presence of cystopathy by means of uroflowmetry and cystometry. Results: All patients with diabetic neuropathy had abnormal urodynamic test results of variable types and degrees with bladder hypercompliance as the most frequent abnormality. Other urodynamic abnormalities were found in both diabetic patients’ groups with no significant difference in frequency. Conclusions: Diabetic neuropathy might be strongly related to urodynamic abnormalities particularly the bladder hypercompliance. Some diabetic patients may have cystopathy in absence of evident neuropathy. This may be due to undetected neuropathy or diabetes induced myopathy of the detrusor muscle.
Cite this paper: Salem, M. , Habashy, S. , Toaima, D. , Shaker, H. , Hetta, O. and El Kafy, J. (2014) Diabetic cystopathy in children and adolescents with Type 1 diabetes mellitus. Journal of Diabetes Mellitus, 4, 19-25. doi: 10.4236/jdm.2014.41004.

[1]   Sima, A.A. (2006) Pathological mechanisms involved in diabetic neuropathy: Can we slow the process? Current opinion in investigational drugs, 7, 324-337.

[2]   Kamalakannan, D., Baskar, V. and Singh, B.M. (2004) Severe and disabling diabetic autonomic neuropathy. Journal of Diabetes and its Complications, 18, 126-128. S1056-8727(03)00004-7

[3]   American Diabetes Association and American Academy of Neurology. (1988) Report and recommendations of the San Antonio Conference on diabetic neuropathy (Consensus Statement). Diabetes, 37, 1000-1004.

[4]   Brown, J.S., Wessells, H., Chancellor, M.B. et al. (2005) Urologic Complications of Diabetes. Diabetes Care, 28, 177-185.

[5]   Poladia, D.P., Schanbacher, B., Wallace, L.J. and Bauer, J.A. (2005) Innervation and connexin isoform expression during diabetes-related bladder dysfunction: Early structural vs. neuronal remodeling. Acta Diabetologica, 42, 147-152.

[6]   Sasaki, K., Chancellor, M.B., Phelan, M.W., Yokoyama, T., Fraser, M.O. and Seki, S. (2002) Diabetic cystopathy correlates with a long-term decrease in nerve growth factor levels in the bladder and lumbosacral dorsal root ganglia. Journal of Urology, 168, 1259-1264. S0022-5347(05)64636-8

[7]   Daneshgari, F., Liu, G. and Imrey, P.I. (2006) Time Dependent Changes in Diabetic Cystopathy in Rats include Compensated and decompensated Bladder Function. The Journal of Urology, 176, 380-386.

[8]   Lee, W.C., Wu, H.P., Tai, T.Y., Liu, S.P., Chen, J. and Yu, H.J. (2004) Effects of diabetes on female voiding behavior. The Journal of Urology, 172, 989-992. 00582-9

[9]   Hampel, C., Gillitzer, R., Pahernik, S., Melchior, S. and Thuroff, J.W. (2003) Diabetes mellitus and bladder function. What should be considered? Der Urologe, 42, 1556-1563. 1007/s00120-003-0456-7

[10]   Levitt, N.S., Stansberry, K.B., Wynchank, S. and Vinik, A.I. (1996) The natural progression of autonomic neuropathy and autonomic function tests in a cohort of people with IDDM. Diabetes Care, 19, 751-754.

[11]   Ewing, D.J. (1992) Analysis of heart rate variability and other non-invasive tests with special reference to diabetes mellitus. In: Bannister, R. and Mathias, C.J. Eds., Autonomic Failure, 3rd Edition. Oxford Medical, Oxford, 312-333.

[12]   Barkai, L. and Madacsy, A. (1995) Cardiovascular autonomic dysfunction in diabetes mellitus. Archives of Disease in Childhood, 73, 515-518.

[13]   Cechetto, D.F. (2000) Autonomic nervous system assessment. In: Terhost, G.J. and Zipes, D.P. Eds. The Nervous System and the Heart, 1st Edition. Humana Press, Totowa, 172-177.

[14]   Scott, W.A. (2001) Assessment of the autonomic nervous system. In: Allen, H.D., Gutgesell, H.P., Clark, E.B. and Driscoll, D.J. Eds. Moss and Adams’ Heart Disease in Infants, Children and Adolescents Including the Fetus and Young Adult, 6th Edition. Lippincott Williams & Wilkins, Baltimore, 172-176.

[15]   Neumann, C. and Schmidt H. (1995) Relationship between the degree of cardiovascular autonomic dysfunction and symptoms of neuropathy and other complications of diabetes mellitus. Brazilian Journal of Medical and Biological Research, 28, 751-757.

[16]   Nitti, V.W. (2005) Pressure flow urodynamic studies: The gold standard for diagnosing bladder outlet obstruction. Reviews in Urology, 7, S14-S21.

[17]   Barkai, L. and Szabó, L. (1993) Urinary bladder dysfunction in diabetic children with and without subclinical cardiovascular autonomic neuropathy. European Journal of Pediatrics, 152, 190-192.

[18]   Boulton, A.J., Vinik, A.I, Arezzo, J.C. et al. (2005) Diabetic neuropathies: A statement by the American Diabetes Association. Diabetes Care, 28, 956-962.

[19]   Donaghue, K.C., Chiarelli, F., Trotta, D., Allgrove, J. and Dahl-Jorgensen, K. (2007) ISPAD clinical practice consensus Guidelines (2006-2007): Microvascular and macrovascular complications. Pediatric Diabetes, 8, 163-170.

[20]   Karavanaki, K. and Baum, J.D. (2003) Coexistence of impaired indices of autonomic neuropathy and diabetic nephropathy in a cohort of children with Type 1 diabetes mellitus. Journal of Pediatric Endocrinology and Metabolism, 16, 79-90.

[21]   Nokleyby, K. and Berg, T.J. (2005) Diabetic neuropathy—A clinical review. Tidsskr Nor Laegforen, 125, 1646-1649.

[22]   Karavanaki, K., Davies, A.G., Morgan, M.H. and Baum, J.D. (1997) Autonomic function in a cohort of children with diabetes. Journal of Pediatric Endocrinology and Metabolism, 10, 599-607.

[23]   Novella, S.P., Inzucchi, S.E. and Goldstein, J.M. (2001) The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve, 24, 1229-1231.

[24]   Blaivas, J.G. (2002) Cause and effect of lower urinary tract symptoms. Journal of Urology, 168, 1464.

[25]   Beylot, M., Marion, D. and Noel, G. (1982) Ultrasonographic determination of residual urine in diabetic subjects: relationship to neuropathy and urinary tract infection. Diabetes Care, 5, 501-505.

[26]   Ueda, T., Yoshimura, N. and Yoshida, O. (1997) Diabetic cystopathy: Relationship to autonomic neuropathy detected by sympathetic skin response. Journal of Urology, 157, 580.

[27]   Szabo, L., Barkai, L. and Lombay, B. (2007) Urinary flow disturbance as an early sign of autonomic neuropathy in diabetic children and adolescents. Neurourology and Urodynamics, 26, 218-221.

[28]   Szabo, L. and Fegyverneki, S. (1995) Maximum and average urine flow rates in normal children—The miskolc nomograms. British Journal of Urology, 76, 16-20.

[29]   Gong, Y., Song, B., Jin, X. and Xiong, E. (2000) Changes in bladder compliance and detrusor contraction/relaxation of diabetic rats. Zhonghua Wai Ke Za Zhi, 38, 865-867.