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Lower Urinary Tract Symptoms in Women with Diabetes Mellitus: A Current Review

From: Rebecca James & Adonis Hijaz

Current Urology Reports, Volume 15, Issue 10, 1 October 2014

Editor’s comments:
Several studies before have indicated the presence of a strong association between lower urinary tract symptoms (LUTS) and Diabetes Mellitus in women  affected by the disease. As an example, in examining the prevalence of stress, urge, and mixed urinary incontinence and associated risk factors in postmenopausal women, a significantly higher prevalence has been reported in diabetic women compared to non-diabetic ones. The authors of this review conducted a literature review of the most current publications studying LUTS in women affected by Diabetes Mellitus, which included articles from January 2013 to April 2014. With regards to nocturia, the condition defined  as ≥ 2 times per night  was found in 59.6% among type II DM patients  answering a self-administered questionnaire. If a more severe nocturia clinical picture (rising ≥3 times per night) was considered, this was present in 25.3% of diabetic patients, which also significantly increased with age and the presence of overactive bladder syndrome. The authors found that other important risk factors were strongly associated with nocturia in diabetic women, such as: a history of stroke, calcium channel blocker use, hypertension, waist circumference greater than standard, and higher serum creatinine level. The duration of DM was strongly associated with nocturia. 

Importantly, severe nocturia increased mortality (OR 1.93) independent of age and DM duration, and had a higher mortality rate compared to diabetics without severe nocturia in 2.5 yrs follow up (6.1 vs. 2.4 %, p=0.001). Thus, there is the need to investigate the presence of nocturia in female patients affected by DM in order to adequately treat this strongly disabling clinical condition, and avoid cardiovascular risks, given the significant association with mortality.

Abstract:
A literature review of the most current publications studying lower urinary tract symptoms (LUTS) and findings in diabetic women was conducted including articles from January 2013 to April 2014. Current reports consistently note that aging and obesity are significantly associated with worsened LUTS in diabetic women. Glucosuria has variable effects on urodynamic parameters and LUTS, but has a significant association with urinary tract infection (UTI) and incontinence at clinically relevant numbers, such as HbA1C values. The presence of severe nocturia in diabetic patients warrants careful surveillance for cardiovascular risks given the significant association with mortality. Diabetics appear to be at higher risk for colonization with the virulent, extended-spectrum, β-lactamase-producing Escherichia coli and Klebsiella species in UTI. Novel therapies in glycemic control and for diabetic bladder dysfunction are undergoing animal model trials with encouraging results. The most promising of these includes stem cell therapy, although a need exists for human studies.