Diabetic cystopathy, which can impair the detrusor muscle function, is a well-recognized urological complication of diabetic autonomic neuropathy in adults. Clinical manifestations of autonomic neuropathy in children with diabetes are fortunately rare, however only a few data have been published on subclinical autonomic disturbances. Immunomodulatory drugs e.g. cytotoxic agents (vinca alkaloids) can also damage the detrusor muscle function. Untreated abnormalities of the detrusor muscle can lead to deterioration of the upper urinary tract as well. Therefore, our aim is to study micturition in children with type 1 diabetes, and the neurotoxic effect of vincristine therapy on bladder function.

We conducted a prospective study which was approved by the Local Ethics Committee. First, we assessed the bladder function of type 1 diabetic children (n=37, girls:17, mean age:13.7 years, SD: ±2.1) with age-, weight- and height-matched controls (n=20). There was no evidence of vascular complications or manifestation of neuropathy in any of the children. Urinary bladder function was assessed by sonography and uroflowmetry. Then, 8 children (girl:1, mean age:12 years, range: 7-17) treated with vincristinum sulfuricum underwent uroflowmetry, too.

In diabetic children Time to maximum flow was longer in diabetic group as compared with controls 11.3±6.3 / 5.8±4.7 sec (P<0.01), and the acceleration (the ratio of maximum flow and the time to maximum flow - Qacc) of diabetics were significantly lower 2.96±1.68 / 6.03±1.23 mL/sec2 (P<0.01). In the Vincristine study, 2 children had Hodgkin’s disease, 3 had non-Hodgkin’s, and 3 had acute lymphocytic leukaemia. 4/8 children had increased bladder volume at first sensation of bladder fullness (205,180,180, and 290 mL), as well as bladder capacity, bladder volume at maximal sensation of bladder fullness, and they had irregular and thickened bladder wall. These patients were treated with vincristine less than 5 days before urodynamics, and the cumulative dose of vincristine was over 10 mg. 3/4 of the children had diminished sensation of bladder fullness. Urinary flow parameters were normal and their micturitions were complete.

Longer Time to first sensation to void, higher voiding volume, as well as lower Qacc in the diabetic group was detected compared to healthy children. Children who were treated with vincristine less than 5 days before urodynamics, had increased bladder volume at first sensation of bladder fullness, bladder capacity, bladder volume at maximal sensation of bladder fullness as well as irregular and thickened bladder wall compared to patients who had vincristine therapy more than 5 days.

Uroflowmetry can detect early alterations in diabetic autonomic neuropathy. Vincristine therapy can alter the bladder function causing reversible neurotoxicity.