Introduction & Objectives: Diabetic cystopathy, characterized by diminished bladder sensation, poor contractility, and increased post-void residual (PVR) urine >100 mL, is understudied in T1D. We describe the distribution of PVR in men and women with T1D enrolled in the Epidemiology of Diabetes Interventions and Complications (EDIC) UroEDIC ancillary study.
Methods: PVR was measured using BladderScan BVI 3000 (Verathon Inc., Bothell, WA) in 450 men and 413 women. Lower urinary tract symptoms (LUTS) were defined by the American Urological Association Symptom Index (AUASI). Kidney disease was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2, neuropathy by symptoms, signs, and abnormal electrophysiology, and cognitive impairment by a decline >1 SD from baseline in psychomotor and mental efficiency.
Results: Mean (SD) age and T1D duration were 63 (7) and 42 (5) years, respectively. Men had significantly higher PVR than women (median [IQR] = 27 [5-94] vs. 5 [1-37] mL, p<0.0001; PVR >100 mL = 23% vs. 9%, p<0.0001). Chronic urinary retention (>300 mL) was present in 4% of men and 1% of women. Older age was associated with higher PVR in men (p=0.01), but not women (p=0.52). Men with vs. without PVR >100 mL had higher median AUASI scores for urgency (p=0.01) and weak stream (p<0.0001). There were no significant differences in AUASI scores for women with and without elevated PVR. Among men, higher PVR volumes were associated with a history of kidney disease (p<0.01), confirmed clinical neuropathy (p<0.001), and cognitive impairment (p=0.03). There were no significant associations between PVR and HbA1c in both men and women.
Conclusion: PVR in long-standing T1D varies by sex. Findings suggest that aging, LUTS, kidney disease, and neuropathy are important factors associated with higher PVR in men only. These findings emphasize the need for sex-specific diagnostic strategies to target optimized interventions for bladder dysfunction at the point of care in men and women with T1D.
B.H. Braffett: None. G.M. Ippolito: None. A. Amighi: None. H. Wessells: None. V.R. Trapani: None. A.M. Jacobson: None. R. Busui: Board Member; American Diabetes Association. Consultant; Procter & Gamble, AstraZeneca, Averitas Pharma, Inc., Bayer Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Ono Pharmaceutical Co., Ltd., Novo Nordisk, Roche Diagnostics. Advisory Panel; ADA/ACC Diabetes by Heart Program. A.V. Sarma: None.
National Institute of Diabetes and Digestive and Kidney Diseases (R01 DK116723-01A1)
