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糖尿病的泌尿生殖系统并发症:发病机制、评估与管理概述

Genitourinary Complications of Diabetes Mellitus: An Overview of Pathogenesis, Evaluation, and Management.

作者信息

Gandhi Jason, Dagur Gautam, Warren Kelly, Smith Noel L, Khan Sardar A

机构信息

Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY 11794. United States.

Foley Plaza Medical, New York, NY. United States.

出版信息

Curr Diabetes Rev. 2017;13(5):498-518. doi: 10.2174/1573399812666161019162747.

Abstract

BACKGROUND

Diabetes mellitus is a vastly prevalent metabolic disorder with escalating global health concerns. Particularly when mismanaged, chronic micro- and macrovascular complications may highly impair physiological systems while immunodeficiency disposes us to infection.

OBJECTIVE

We investigate infections, localized complications, and neoplasms of the genitourinary system secondary to the chronic complications of diabetes mellitus in males and females.

METHOD

A comprehensive MEDLINE® search was guided using key words relevant to diabetes mellitus and the genitourinary system.

RESULTS

Pathogen-friendly environments may implicate the sequelae of urinary tract and genital mycotic infections, potentially generating necrosis, abscess, and other inflammatory complications, which may present concomitantly with neurogenic and/or vasculogenic dysfunction to further exacerbate an existing genitourinary condition. Manifestations of the adrenal, renal, and genital organs and tissues are discussed as they relate to vascular, immunodeficient, and other hyperglycemic complications of the diabetic state. Among those, chronic kidney disease and cystopathy are the most prevailing and detrimental. Though studies have connected diabetes to either an increased risk of developing or poor prognosis of bladder, renal, prostate, endometrial, and cervical cancers, the explicit biological relationships are as of yet inconclusive.

CONCLUSION

Despite the availability of precise treatments to ameliorate most presently reviewed conditions, particularly urinary tract and genital mycotic infection-related sequelae, reversing permanent vascular damage remains a great challenge. Leading a healthier lifestyle and managing diabetes mellitus with a patient-centric approach from the outset are the most putative methods for preventing critical long-term genitourinary manifestations of diabetes mellitus.

摘要

背景

糖尿病是一种极为普遍的代谢紊乱疾病,全球健康问题日益严重。特别是管理不善时,慢性微血管和大血管并发症可能严重损害生理系统,而免疫缺陷会使我们易受感染。

目的

我们研究男性和女性糖尿病慢性并发症继发的泌尿生殖系统感染、局部并发症和肿瘤。

方法

使用与糖尿病和泌尿生殖系统相关的关键词进行全面的医学文献数据库(MEDLINE®)检索。

结果

有利于病原体生长的环境可能与泌尿道和生殖器霉菌感染的后遗症有关,可能导致坏死、脓肿和其他炎症并发症,这些并发症可能与神经源性和/或血管源性功能障碍同时出现,进一步加重现有的泌尿生殖系统疾病。讨论了肾上腺、肾脏以及生殖器官和组织的表现与糖尿病状态下的血管、免疫缺陷和其他高血糖并发症的关系。其中,慢性肾病和膀胱病最为常见且有害。尽管研究已将糖尿病与膀胱癌、肾癌、前列腺癌、子宫内膜癌和宫颈癌的发病风险增加或预后不良联系起来,但确切的生物学关系尚未定论。

结论

尽管有精确的治疗方法可改善目前所讨论的大多数病症,特别是与泌尿道和生殖器霉菌感染相关的后遗症,但逆转永久性血管损伤仍然是一项巨大挑战。从一开始就以患者为中心的方法引领更健康的生活方式并管理糖尿病,是预防糖尿病严重长期泌尿生殖系统表现的最有效方法。

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