Diabetic cystopathy

Diabetes mellitus is a systemic disease estimated to affect 7% of the US population. Patients with diabetes cannot properly regulate glucose in the body secondary to insulin deficiency or insulin resistance. The resultant hyperglycemic environment leads to a variety of complications, including diabetic cystopathy, which refers to the effects of diabetes on the bladder. The clinical presentation of diabetic cystopathy varies dramatically. Patients may be asymptomatic, or have a wide variety of voiding complaints. On urodynamic testing, cystopathy is characterized by a hyposensate, acontractile detrusor muscle. In some patients, urgency and involuntary detrusor activity predominate. Diagnosis is made with history and physical examination as well as urodynamic evaluation. Treatment is guided by urodynamic findings. This review focuses on diagnosis and treatment of diabetic cystopathy, emphasizing pathophysiology and recent developments in our understanding of the effects of diabetes on the bladder.