To explore the problem of initial manifestations of the diabetic neurogenic bladder, diabetic patients with and without neuropathy and nondiabetic controls, all without symptoms or signs referable to the urinary tract, were studied urologically. The nondiabetic controls and the diabetics without neuropathy were normal. In striking contrast, 83 per cent of diabetic patients with neuropathy had clear, objective evidences of neurogenic bladder involvement as manifested by abnormal cystometrograms, and grossly enlarged bladders. However, the absence of residual urine was the rule. The typical case had no pyuria or bacteriuria, a negative bladder urine culture, no azotemia, pyelonephritis, sepsis or significant albuminuria.
This differs sharply from the advanced diabetic neurogenic bladder with paralysis where there is a marked residual urine with secondary infection, pyuria, bacteriuria, positive urine cultures, pyelonephritis, sepsis, azotemia and conspicuous albuminuria. The disparity is determined by the factor of residual urine which is the measure of decompensation.
It is suggested that the progressive decompensation of the incipient asymptomatic diabetic bladder is a cause of the increased frequency of renal infection in the diabetic.