Urologic Diseases and Sexual Dysfunction in Diabetes

Diabetes impacts the function and structure of the lower urinary tract, including the bladder and prostate, which can lead to complications such as urinary incontinence, poor bladder emptying, sexual dysfunction, lower urinary tract symptoms (LUTS), and urinary tract infection. Although urologic complications increase with age in the general population, urologic complications are even more common in individuals with diabetes compared to those with normal glucose. It has been estimated that risk of urologic complications is increased 25% to 200% in men and about 50% to 200% in women among those with diabetes compared to those with normal glucose. In men with diabetes, common urologic complications include LUTS and benign prostatic hyperplasia (BPH), a histological diagnosis associated with growth of the prostate gland. LUTS, the most common clinical manifestation of BPH, occur more frequently among men with diabetes compared to men with normal glucose. Similarly, men with diabetes more commonly have BPH. The interplay of LUTS, BPH, and diabetes remains unclear. Erectile dysfunction (ED) is also common in men with diabetes, with a prevalence estimated at 23%–90%. Although less studied, type 1 diabetes appears to increase the risk of ED in a similar fashion as type 2 diabetes. In women, sound epidemiologic evidence from several studies has linked type 1 and type 2 diabetes and urinary incontinence. Prevalence of incontinence has been estimated to be about 50%–200% more common in women with type 2 diabetes than in women with normal glucose. Data on the incidence of incontinence reflect a similar pattern. There is also evidence that women with prediabetes are at higher risk for incontinence. Less research has been conducted on women with type 1 diabetes; however, incontinence also appears to be more prevalent among women with type 1 diabetes compared with women without diabetes. Health care providers should be alert for urologic complications among their patients with diabetes because these conditions are common and often go unrecognized and, thus, undertreated. Future research is needed to identify mechanisms and effective treatment and prevention strategies to decrease the psychosocial, medical, and economic costs of these chronic disorders in many men and women with diabetes.