Lee Wei-Chia, Wu Huey-Peir, Tai Tong-Yuan, Yu Hong-Jeng, Chiang Po-Hui
Division of Urology, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.
J Urol. 2009 Jan;181(1):198-203. doi: 10.1016/j.juro.2008.09.021. Epub 2008 Nov 14.
We studied urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in diabetic women.
A total of 86 consecutive type 2 diabetic women with minimal confounders of voiding dysfunction followed at a diabetes clinic were prospectively enrolled and subjected to urodynamic studies. The sensory response of Adelta and C fibers of the bladder was measured by intravesical current perception threshold testing at frequencies of 250 and 5 Hz, respectively.
Of these 86 women 30 (34.9%) were classified as having detrusor underactivity, 12 (14.0%) presented signs of detrusor overactivity, 11 (12.8%) were referred to as having bladder outlet obstruction and 33 (38.4%) showed normal detrusor function on urodynamics. The normal detrusor function group was the reference group. The detrusor underactivity group showed impaired emptying function and decreased sensation on cystometry and intravesical current perception threshold testing. The detrusor overactivity group showed impaired storage and emptying function but had no significant changes in intravesical current perception threshold values. When the normal detrusor function group and detrusor underactivity group were pooled to perform multivariate analysis, an increase in current perception threshold values was associated with a decrease in bladder voiding efficiency on 5 and 250 Hz current perception threshold testing.
Our data provide the electrophysiological evidence that indicates an association between impaired Adelta as well as C fiber bladder afferent pathways and poor emptying function in diabetic women with detrusor underactivity. Diabetes can affect the bladder presumably via peripheral pathogenetic mechanisms to induce detrusor overactivity with impaired contractility.
我们研究了糖尿病女性膀胱功能障碍早期的尿动力学特征和膀胱感觉功能。
前瞻性纳入了86例连续的2型糖尿病女性，她们在糖尿病诊所就诊，排尿功能障碍的混杂因素最少，并接受了尿动力学研究。分别通过频率为250Hz和5Hz的膀胱内电流感觉阈值测试来测量膀胱Aδ纤维和C纤维的感觉反应。
在这86名女性中，30例（34.9%）被归类为逼尿肌活动低下，12例（14.0%）表现出逼尿肌活动亢进的迹象，11例（12.8%）被认为存在膀胱出口梗阻，33例（38.4%）在尿动力学检查中显示逼尿肌功能正常。逼尿肌功能正常组为参照组。逼尿肌活动低下组表现出排空功能受损，膀胱测压和膀胱内电流感觉阈值测试的感觉减退。逼尿肌活动亢进组表现出储尿和排空功能受损，但膀胱内电流感觉阈值无显著变化。当将逼尿肌功能正常组和逼尿肌活动低下组合并进行多因素分析时，电流感觉阈值升高与5Hz和250Hz电流感觉阈值测试时膀胱排尿效率降低相关。
我们的数据提供了电生理证据，表明Aδ纤维和C纤维膀胱传入通路受损与逼尿肌活动低下的糖尿病女性排空功能不良之间存在关联。糖尿病可能通过外周发病机制影响膀胱，导致逼尿肌活动亢进伴收缩力受损。
