Autonomic neuropathy and urologic complications in diabetes

Abstract

Diabetic autonomic neuropathy affects the entire autonomic nervous system and can lead to dysfunction of the cardiovascular, gastrointestinal, and genitourinary organ systems. Genitourinary dysfunction associated with diabetic autonomic neuropathy includes diabetic bladder dysfunction, sexual dysfunction, and recurrent urinary tract infections. Urological complications in diabetes mellitus are very common; in fact, genitourinary complications are more common than diabetic neuropathy or nephropathy. While several studies have reported on genitourinary dysfunction in individuals with diabetes, UroEDIC, an ancillary study to the Diabetes Control and Complications Trial (DCCT) and its observational follow up, the Epidemiology of Diabetes Interventions and Complications study (EDIC), comprehensively characterized the association between urologic complications and cardiovascular autonomic neuropathy. UroEDIC demonstrated significant associations between autonomic neuropathy and urologic complications in type 1 diabetes, specifically erectile dysfunction, female sexual dysfunction, and lower urinary tract symptoms. In this narrative review, we review the current literature on urological complications in diabetes.

Keywords: Autonomic neuropathy; Bladder dysfunction; Diabetes; Erectile dysfunction; Sexual dysfunction.

Figure 1a and 1b.. Increased Prevalence of Urologic complications in men (a) and women (b) from Uro EDIC year I and II.

Data from Wessels, H. et al., 2018, Diabetes Care Increased prevalence of urologic complications from EDIC I to EDIC II in men and women. Cohort totals: Women n=508, Men n=551 *EDIC: Epidemiology of Diabetes Interventions and Complications study *LUTS: Lower Urinary Tract Symptoms *FSD: Female Sexual Dysfunction *UI: Urinary Incontinence *UTI: Urinary Tract Infection *ED: Erectile Dysfunction *LD: Low Desire *OD: Orgasmic Dysfunction