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Incidence of lower urinary tract dysfunctions in diabetic patients placed on the waiting list for a combined kidney and pancreas transplantation and their relationship to the severity of diabetes mellitus
IUGA Academy. Mokriš J. Jun 30, 2018; 212917
Topic: Dysfunctional Voiding
Jan Mokriš
Jan Mokriš

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344

Incidence of lower urinary tract dysfunctions in diabetic patients placed on the waiting list for a combined kidney and pancreas transplantation and their relationship to the severity of diabetes mellitus

Mokriš, J1; Zachoval, R2; Petr, R3; Lovasová, V4; Kožnarová, R5

1: Department of Urology, Thomayer hospital, 3. Faculty of Medicine, Charles University in Prague , Czech Republic; 2: Department of Urology, Thomayer hospital, 1.and 3. Faculty of Medicine, Charles University in Prague , Czech Republic; 3: Department of Neurology, Thomayer hospital, Prague, Czech Republic; 4: Department of Transplant Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic; 5: Department of Diabetology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic

Introduction: diabetes mellitus is a chronic metabolic disorder whose incidence is rising worldwide, it is associated with high morbidity and mortality. As a result of this disease there are complications- development of diabetic nephropathy, neuropathy and retinopathy. The complications associated with this disease include lower urinary tract dysfunction which occurs in up to 80% of diabetic patients.

Objective: to assess the presence of lower urinary tract dysfunctions in diabetic patients placed on the waiting list for a combined kidney and pancreas transplantation. Correlation of lower urinary tract dysfunctions with parameters of severity of diabetes mellitus.

Methods: 97 patients underwent complex pre-transplantation examination in urology. From that group 77 patients also underwent examination in diabetology, nephrology, ophthalmology and neurology.

Measured parameters

Urological: 1. uroflowmetry: Qmax (ml/s) 2. filling cystometry: Cmax (ml), Compliance (ml/cmH2O), presence of detrusor involuntary contractions 3. voiding cystometry:

Obstruction: men according to Bladder Outlet Obstraction Index, women according to Blaivas-Groutz nomogram

Hypocontractility: - men according to Bladder Contractility Index

-woman according to formula: hypocontractility is present if Qmax < 12 and at the same time PdetQmax < 10

Ophthalmological: visual impairment and blindness according to WHO

Nephrological: glomerular filtration- GFR (ml/s), proteinuria (g/24h), Creatinine

Diabetological: glycated hemoglobin- HbA1c (mmol/mol) , grade of autonomic neuropathy measured according to Ewing's battery of cardiovascular tests

Neurological: grade of peripheral neuropathy according to electromyography

Results: we investigated 97 patients, 67 men and 30 women. From the data file we were interested to seven continuous variables - Cmax (average 301ml), compliance (average 89,6ml/cmH2O), Qmax (average 14ml/s), Qave (mean 7ml/s), GFR (mean 0.27), proteinuria (mean 4.7g/24h) and HbA1c (average 72) . Average value of BOO was 19. Avarage value of BCI was 106.

No of patients with pathol.

value

Average pathol.

value

Range of measured pathol. values

No of mens with pathol. value

No of womens with pathol. values

Qmax

53

10,3ml/s

1-15ml/s

39 (mean 10,8ml/s )

14 (mean 9,4ml/s)

Cmax

68

222ml

92-350ml

50 (average 218ml)

18 (average 240ml)

compliance

38

16,1ml/cm H2O

1–29ml/cm H2O

28 (average 15,7ml/cm H2O)

10 (average 18ml/cm H2O)

involuntary contractions

5

5

-

obstruction

15

11

4

hypocontractility

25

22

3

Conclusions:

We have found a large number of dysfunctions of lower urinary tract in patients placed on the waiting list for a combined kidney and pancreas transplantation. The most frequent dysfunctions are decreased urinary bladder capacity, lower compliance, urinary bladder hypocontractility and obstruction of lower urinary tract.

We have not found any correlation between lower urinary tract dysfunctions and parameters of severity of diabetes mellitus. These results are probably caused by extremely advanced and extensive damage of tissue and organ systems in the patient group that is placed on the waiting list for a combined kidney and pancreas transplantation.

To confirm a relationship between lower urinary tract dysfunctions and severity of diabetes mellitus it will be necessary to perform further studies in patients with earlier stages of diabetes mellitus.

Disclosure:

Work supported by industry: no.

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