Urologic complications

Diabetes is associated with an earlier onset and increased severity of urological conditions, resulting in debilitating urologic complications that have a huge impact on the life quality of both male and female patients. Below is a review of most common complications and recommendations for clinical care.

Bladder dysfunction. It is a progressive condition that encompasses a number of lower urinary tract symptoms, including urinary frequency, urgency, incontinence and nocturia.

A diabetic bladder is instable and hypersensitive, causing a variety of symptoms due to nerve damage that makes the bladder lose its ability to sense when it is full. This results in a tendency to retain large amounts of urine in the bladder. As the bladder muscle stretches to accommodate increasingly larger volumes, it begins to lose its normal tone and eventually becomes unable to empty completely. And if the bladder is not completely emptied, its remaining capacity fills up more quickly, triggering frequent urination.

If the bladder isn’t emptied regularly, it can become so full that it overcomes the sphincter muscle and overflows, which results in incontinence.

Treatment is simple – the bladder must be emptied regularly and fully, but this may require some effort. Some patients may benefit from catheterization, which allows the bladder to drain and its muscles to regroup. Others may benefit from pelvic muscle training, medications and surgery.

Kidney disease. Diabetes accounts for nearly 45% of kidney failure – the end stage of kidney disease, also known as nephropathy. It takes decades to develop. In the first few years of diabetes, the filtering function of the kidneys is usually higher than normal. Over several years, patients start to have small amounts of the blood protein albumin leaking into the urine. At this, the filtration function still remains normal. But as the kidney disease progresses, more albumin leaks into the urine and the filtering function starts to decline. As a result, the body retains various wastes, one of which is creatinine (often used in blood tests to estimate the decline in kidney filtration).

In general, kidney damage occurs in the first decade of having diabetes, and it usually takes 15-25 years for the kidney failure to happen, even when diabetes is controlled.

Urinary tract infections. UTIs are caused by bacteria, generally from the bowels. Normally, the urinary tract system has natural barriers to protect the body against organisms that cause infections, such as ureters. Urination process also helps to flush out microbes and bacteria. And a healthy immune system helps to resist any infection as well.

But diabetes can hamper the immune system function due to poor blood circulation, which lowers the ability of white blood cells to circulate in the body and fight off infection. Moreover, high blood sugar itself can raise the risk of UTIs. Finally, diabetics may not empty their bladders as fully as they should, and the urine stays in the bladder becoming a breeding ground for bacteria which easily develops into an infection.

Infections are treated with antibiotics for 3 or more days in severe cases. Prevention includes drinking plenty of liquids (especially) water, consuming dairy foods that contain probiotics and wearing cotton underwear.

While most urologic symptoms and complications can be successfully treated, intensive glycemic control delays their onset and progression, as well as improves their severity.

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