Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China.
J Diabetes. 2015 Jul;7(4):442-7. doi: 10.1111/1753-0407.12272. Epub 2015 Mar 24.
Herein we review and discuss epidemiological, clinical, and experimental studies on diabetic cystopathy, a common chronic complication of diabetes mellitus with a variety of lower urinary tract symptoms, providing directions for future research. A search of published epidemiological, clinical, or preclinical trial literature was performed using the key words "diabetes", "diabetic cystopathy", "diabetic bladder dysfunction", "diabetic lower urinary tract dysfunction", "diabetic detrusor instability". The classic symptoms of diabetic cystopathy are decreased bladder sensation, increased bladder capacity, and impaired bladder emptying with resultant increased post-void residual volume. However, recent clinical evidence indicates a presence of storage symptoms, such as overactive bladder symptoms. The pathophysiology of diabetic cystopathy is multifactorial, including disturbances of the detrusor, neuron, urothelium, and urethra. Hyperglycemia, oxidative stress, and polyuria play important roles in inducing voiding dysfunction in diabetic individuals. Treatment choice depends on clinical symptoms and urodynamic abnormalities. Urodynamic evaluation is the cornerstone of diagnosis and determines management strategies. Diabetes mellitus could cause a variety of lower urinary tract symptoms, leading to diabetic cystopathy with broadly varied estimates of the prevalence rates. The exact prevalence and pathogenesis of diabetic cystopathy remains to be further investigated and studied in multicenter, large-scaled, or randomized basic and clinical trials, and a validated and standardized workup needs to be made, improving diabetic cystopathy management in clinical practice. Further studies involving only female diabetics are recommended.
本文回顾和讨论了糖尿病性膀胱病的流行病学、临床和实验研究，糖尿病性膀胱病是糖尿病的一种常见慢性并发症，具有多种下尿路症状，为未来的研究提供了方向。使用关键词“糖尿病”、“糖尿病性膀胱病”、“糖尿病膀胱功能障碍”、“糖尿病下尿路功能障碍”、“糖尿病性逼尿肌不稳定”，对已发表的流行病学、临床或临床前试验文献进行了检索。糖尿病性膀胱病的典型症状为膀胱感觉减退、膀胱容量增加和排空障碍导致残余尿量增加。然而，最近的临床证据表明存在储存症状，如膀胱过度活动症。糖尿病性膀胱病的病理生理学是多因素的，包括逼尿肌、神经元、尿路上皮和尿道的紊乱。高血糖、氧化应激和多尿在诱导糖尿病个体排尿功能障碍中起重要作用。治疗选择取决于临床症状和尿动力学异常。尿动力学评估是诊断的基石，决定了治疗策略。糖尿病可引起多种下尿路症状，导致糖尿病性膀胱病，其患病率的估计差异很大。糖尿病性膀胱病的确切患病率和发病机制仍需进一步在多中心、大规模或随机的基础和临床研究中进行调查和研究，并需要进行验证和标准化的评估，以改善临床实践中的糖尿病性膀胱病管理。建议仅对女性糖尿病患者进行进一步的研究。
