Only 14 pages are availabe for public view
Diabetic autonomic neuropathy affecting the urogenital tract
includes diabetic cystopathy and complex sexual functional
disturbances in women including loss of libido as well as the inability to
become aroused, the absence of orgasm or Dyspareunia.
Diabetic cystopathy can progress insidiously over the time without
any symptoms, manifesting itself at a later stage. This insidious progress
increases the risk of secondary complications.
Therefore, early diagnosis in the asymptomatic stage of diabetic
cystopathy with simple non invasive method is of utmost importance.
This study was carried out to evaluate the different
electrophysiological studies (including genital sympathetic skin
response, somatosensory evoked potential of tibial nerve) in early
detection of urinary and sexual dysfunction in diabetic female in relation
to urodynamic study and female sexual dysfunction index questionnaire
We conducted our study on 30 diabetic females and 10 healthy
subjects who served as a control group. All patients were stratified into
two groups according to LUTS and LUTD and then subjected to history
taking, FSFI questionnaire and clinical examination with special
emphasis on pelvic neurological examination.
For diagnosis of diabetic bladder dysfunction all patients were
subjected to urodynamic studies which showed different
pathophysiological findings. Electrophysiological studies were done for all patients included:
1. Motor nerve conduction of tibial and common peroneal nerve.
2. Sensory nerve conduction of sural nerve
3. Sympathetic skin response (SSR) of genital, hand, foot
4. Somatosensory evoked potential of tibial nerve.
Our study revealed:
1. Statistically high significant between urodynamic study and
2. Statistically significant between urodynamic study and SSEP P40
of tibial nerve.
3. Sural nerve had high sensitivity and specificity in early stages and
low specificity in late stages of diabetic bladder dysfunction.
Our results showed that all parameters of urodynamic study had no
significant correlation with electrophysiological except for residual
urine volume which had significant correlation with SSEP of tibial and
high significant correlation with genital SSR in both groups of patients.
As regards sexual function assessment there was a statistically high
significant correlation with genital SSR in both groups of patients.
To sum up, diabetic bladder dysfunction (diabetic cystopathy) might
be presented with different clinical pictures; classical presentation was
rare; although urodynamic study is essential for actual diagnosis and
detection of variable pathophysiological changes; Electrophysiological
studies especially genital SSR and SSEP P40 of tibial nerve abnormalities raise the possibility of having DBD and draw our attention
for further evaluation at early stages of DBD.