Vol.64 No.5 September 2016
Pathophysiology and management of urinary tract infections in patients with diabetic bladder dysfunction
1)Department of Urology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, Japan
2)Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine
Abstract
Urinary tract infections (UTIs) are common complications in patients with diabetes mellitus (DM). UTIs in DM patients are classified as complicated ones, which easily recur, are aggravated, and are caused by antibiotic-resistant bacteria. One of the causative factors of UTIs in patients with DM is the higher prevalence of asymptomatic bacteriuria (ASB), particularly in postmenopausal females, than in those without DM. ASB is putatively thought to be associated with the existence of lower urinary tract dysfunction (LUTD), which is also a common complication of DM. Although about 80% of patients with DM are thought to have some kind of LUTD, most of them are asymptomatic cases. The classical symptoms of diabetic bladder dysfunction (DBD), also called diabetic cystopathy, are decreased bladder sensation, increased bladder capacity, detrusor muscle impairment, and increased post-void residual volume. However, recent clinical and basic investigations have shown that the pathophysiology of DBD is multifactorial, with not only peripheral autonomic neural dysfunction but also disturbances of the detrusor, urothelium, and central nervous system being associated with DBD. Therefore, the lower urinary tract symptoms of DM patients vary and change over time. At present, there is no definitive answer as to whether DBD itself is a risk factor for UTI in such patients. In addition, prophylactic antibiotic therapy for ASB is not required to reduce the risk of symptomatic UTI. However, based on these facts, appropriate management for DBD is recommended to prevent complicated UTI. Moreover, it is important to monitor urine cultures regularly and to conduct definitive antimicrobial therapy based on the results in advance when we perform invasive treatment of the urinary tract in such patients.
Key word
diabetes mellitus, bladder dysfunction, urinary tract infection
Received
December 21, 2015
Accepted
December 25, 2015
Jpn. J. Chemother. 64 (5): 730-734, 2016
