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Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 561  

Does urodynamics study help in evaluation and prognosis of treatment in benign prostatic hyperplasia with diabetes mellitus?


Departmnt of Urology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India

Date of Web Publication17-Jan-2018

Correspondence Address:
D K Jain
Departmnt of Urology, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_160_17

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How to cite this article:
Jain D K. Does urodynamics study help in evaluation and prognosis of treatment in benign prostatic hyperplasia with diabetes mellitus?. Med J DY Patil Univ 2017;10:561

How to cite this URL:
Jain D K. Does urodynamics study help in evaluation and prognosis of treatment in benign prostatic hyperplasia with diabetes mellitus?. Med J DY Patil Univ [serial online] 2017 [cited 2020 Jan 29];10:561. Available from: http://www.mjdrdypu.org/text.asp?2017/10/6/561/223359



Benign prostatic hyperplasia (BPH) with lower urinary tract symptoms (LUTS) is a common health problem affecting 50% of men older than 50 years of age, and similarly, diabetes mellitus (DM) is another common disease occurring in the same age group. Both affect bladder function producing obstructing and irritative symptoms.[1] The distinction between LUTS secondary to DM and BPH is difficult and often they overlap. It is in such a situation where urodynamic evaluation plays an important role to distinguish the primary cause of LUTS and thereby helping the urologist in deciding the appropriate line of management.

Diabetic bladder dysfunction presents in a spectrum of clinical symptoms representing a number of disorders ranging from bladder overactivity to impaired bladder contractility.[2] Its prevalence has been estimated as being between 25% and 87% (Frimodt-Møller, 1980). Diabetic bladder dysfunction can also present as an overactive bladder (OAB) syndrome. More than half (~55%) of diabetic patients have detrusor hyperreflexia (DH), 23% have decreased detrusor contractility (DU), 10% demonstrate detrusor areflexia (DA) with remaining 11% showing indeterminate findings.[3]

The term diabetic cystopathy was used by Frimodt Moller in 1976[4] and refers to LUTS due to diabetic neuropathy. Diabetic cystopathy is characterized by increased postvoid residual volume and enhanced bladder capacity with decreased bladder sensation and contraction secondary to damage of visceral afferent fibers in bladder wall.[5] It is a well-recognized complication of DM which usually develops in middle-aged or elderly patients with long-standing or poorly controlled disease.

Two indices have been used to predict bladder outlet obstruction (BOO) and bladder contractility, i.e., BOO index (BOOI) and bladder contractility index (BCI) which are derived as follows:

BOOI = Pdet Qmax-2Qmax

BCI = Pdet Qmax-+5Qmax

BOOI > 40 = BOO, BCI < 40 DU

Diabetic patients with voiding dysfunction have varied urodynamic findings.[6]

Findings of UDS in various studies of patients with DM are shown in [Table 1].
Table 1: Findings of UDS in various studies of patients with DM

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To conclude, urodynamic study plays an important role in helping the urologist to decide the line of management in diabetic male patients with LUTS. In addition to this, some authors acknowledge that urodynamic analysis can be used to predict the symptomatic outcome after TURP.[6]



 
  References Top

1.
Stamatiou K, Lardas M, Kostakos E, Koutsonasios V, Michail E. The impact of diabetes type 2 in the pathogenesis of benign prostatic hyperplasia: A review. Adv Urol 2009;2009:3.  Back to cited text no. 1
    
2.
Golbidi S, Laher I. Bladder Dysfunction in Diabetes Mellitus. Front Pharmacol 2010;1:1-9.  Back to cited text no. 2
    
3.
Kaplan SA, Te AE, Blaivas JG. Urodynamic findings in patients with diabetic cystopathy. J Urol 1995;153:342-4.  Back to cited text no. 3
[PUBMED]    
4.
Hill SR, Fayyad AM, Jones GR. Diabetes mellitus and female lower urinary tract symptoms: a review. Neurourol Urodyn 2008;27:362-7.  Back to cited text no. 4
[PUBMED]    
5.
Kebapci A, Yenimez A, Demirustu SC. Bladder dysfunction in type 2 diabetes patients. Neurouro Urodyn 2007;26:814-9.  Back to cited text no. 5
    
6.
Rageri D, Sekar H, Krishnamoorty S, Kumaresan N, Ramanan V. Urodynamic evaluation in men over 50 years with diabetes mellitus and lower urinary tract symptoms: A single center experience. J Urol 2017;4:652.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1]



 

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