Diabetes mellitus (DM) is a common health issue which is associated with lower urinary tract symptoms (LUTs) and bladder dysfunction. A variety of urodynamic findings were reported with diabetic patients (1). However, there is paucity in the literature evaluating the urodynamic pattern comparing both short and long-standing diabetic patients. Therefore, the aim of the present study was to address the pattern of urodynamic findings in diabetic patients presenting with lower urinary tract symptoms (LUTS), comparing both short term and long-standing DM.

After obtaining ethics approval, a prospective study was conducted on 50 patients consecutively presenting with LUTS symptoms and having a concomitant diagnosis of DM type 2, between February 2016 and May 2018. All subjects signed informed consents to participate in the study. They all underwent urodynamic evaluation using Ellipse-4 Andromeda machine (GmbH, Wallbergstraße 5. D-82024 Taufkirchen/Potzham- Germany). Patients with previous pelvic surgery and/or with concurrent neurologic disorders, or any other condition that interfere with bladder or sphincter function were excluded from the study. Patients were classified and evaluated according to the duration of diabetes into short duration – less than 15 years – (62%) and long duration (38%) – over 15 years. 
Statistical analysis was done using SPSS software package version 20.0. Numerical values were presented as mean + SE. Categorical values were presented as frequency and percentages. Comparison between different categorical variables was done using Chi-square test or Fischer exact test. Two tailed P values less than 0.05 were considered statistically significant.

A total of 50 patients were included in the study. Mean duration of DM was 15±0.77 years (range 10 to 29 years). We recruited 10 men (20%) and 40 women (80%). The mean age was 56.28 ±1.14 years (range 45 to 73 years), Mean HbA1c was 7.5% ±1.2, and mean fasting blood sugar (FBS) was 199.88 ± 9.24 mg% (range 102 to 392 mg%). Voiding diary charts were reported as the mean of variable per patient as following; diurnal voids/day were 7.78 + 0.45 (range 2 to 15), and nocturnal voids/night were 3.78 + 0.29 (range 0 to 8). Mean of urgency episodes/day were 4.54 + 0.48 (range 0 to 14), and mean urgency incontinence episodes/day were 2.17 + 0.51 (range 0 to 14) while mean voided volume /void was 268.47 ml + 14.86 (range 90 to 500). Patients’ clinical presentation and LUTs were presented in (Table 1).
With regards to urodynamic evaluation, detrusor overactivity (DO) and increased bladder sensation were more common in patients with short duration DM (35.5 vs. 15.8%, p=0.01) and (32.3 vs. 5.3%, p=0.01) respectively whereas weak or absent detrusor contractility were more frequent in patients with long-standing DM. As expected, overflow incontinence and straining during voiding were significantly higher with long duration group (p=0.04 and p=0.03) respectively. Surprisingly, there was no significant correlation between patients presenting with urgency on voiding diary (subjective) and urodynamic detection of DO (p= 0.07).

The present study demonstrated that DM patients had different bladder dysfunction patterns according to the duration of DM. Storage symptoms were more common among short duration patients including nocturia (90.3 vs. 84.2%), daytime frequency (90.3 vs. 78.9%), urgency (83.9 vs. 68.4%), and urge incontinence (58.1 vs. 47.4%). In contrast, voiding symptoms were more common in long-standing DM including weak stream (63.2 vs. 22.6%), interrupted stream (57.9 vs. 19.4%), overflow incontinence (42.1 vs. 6.5) and straining during voiding (68.4 vs. 22.6%); (Table 1). Since subjective evaluation in terms of voiding diary could not reflect the objective bladder dysfunction on urodynamic study, we believe it is crucial to create a new validated screening test for patients with diabetic cystopathy. Further studies with larger sample size are advisable.

There are different patterns in urodynamic characterizations of type 2 diabetic patients. Patients with short-standing DM present more commonly with storage symptoms and detrusor overactivity on urodynamics, and patients with long-standing DM present more frequently with voiding symptoms and detrusor underactivity on urodynamics. Screening for underactive bladder may be indicated in patients with a long-standing duration of DM.

Bansal R, Agarwal MM, Modi M, Mandal AK, Singh SK. Urodynamic profile of diabetic patients with lower urinary tract symptoms: association of diabetic cystopathy with autonomic and peripheral neuropathy. Urology. 2011;77(3):699-705.