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Pathophysiological signals in the urine of Diabetics from a tertiary LUTS clinic, routine outpatient diabetic clinic and controls
IUGA Academy. Swamy S. Jun 30, 2018; 213018
Topic: Pelvic Pain
Sheela Swamy
Sheela Swamy

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Pathophysiological signals in the urine of diabetics from a tertiary LUTS clinic, routine outpatient diabetic clinic and controls

Swamy, S1; Aldous, G1; Braham, N1; Sathiananthamoorthy, S2; Malone-Lee, EPJ2

1: University College London; 2: UCL

Background: Lower urinary tract symptoms referred popularly as LUTS is a global problem. 3 large population based studies have consistently shown that the prevalence of LUTS is almost similar in the two genders and it steadily increases with age (1, 2). A survey of 1000 diabetes patients revealed that prevalence of UTI was 25.3% (7.2% in males and 41.1% in females) and this did not vary between Type 1 and Type 2 diabetes patients (3). Screening for LUTS & UTI is not undertaken as a part of routine assessment even in secondary level endocrine clinics which mainly cater to poorly controlled Diabetes patients. Frequency and Urgency in these patients is attributed to Diabetes itself and the pathology goes undetected.

Aims: To study the pathophysiological signals in the urine of diabetic patients attending tertiary LUTS clinic, attending routine outpatient diabetes clinic and compare them to controls.

Ethics: Ethical committee approval from NRES Committee South East Coast – Surrey, Ref-11/LO/0109

Methods: A cross-sectional observational cohort study was conducted from November 2013 to November 2014 at Whittington Hospital and healthy female volunteers were recruited as controls. 25 Diabetes patients referred to LUTS clinic, 28 Diabetic patients attending their routine endocrine clinic appointment and 29 healthy volunteers participated in the study. Variations in symptoms are being measured using validated questionnaires... The microbiological evidence of infection was evaluated through, microscopy of fresh urine for pyuria and epithilial cell shedding and urinary cell sediment culture and identification of bacteria to the genus level. The urine cytology was assessed using epiflorescent staining of urothelial cells and the proportion of clue cells recorded.

Results: There was a significant difference in the 24-hour frequency, Incontinence, urgency, voiding and pain scores between both groups of diabetics and controls. There was a significant difference in the Mean clue cell proportion, Log Sediment Culture count, log white and epithelial cell counts between the diabetics and controls. The diversity of the microbiome varied amongst the 3 groups: Controls had 3 microbes, OPD Diabetics grew 4, and LUTS clinic patients grew 4.5 microbes per person. A predominance of E coli, KES, Proteus and Pseudomonas was noted in the Diabetics from LUTS clinic compared to controls and Outpatient diabetics on Sediment Cultures using CPS3 agar. Figure 1 illustrates that bladders are not sterile and using Kass’s threshold for diagnosis or any quantitative threshold, however low will not differentiate between a patient and control.

Conclusion: The preliminary observational data from our study suggest that Diabetic patients vary considerably from controls. LUTS symptoms in the diabetic patients should not be attributed to diabetes alone and should alert a clinician to exclude a UTI.

References:

  1. EpiLUTS Study, Arch Int ern Med 2009
  2. ICS, Standardised terminology committee 2011
  3. World J Urol. 2013 Jun; 31(3):573-8

Fig1: Diversity of the Microbiome


Disclosure:

Work supported by industry: no.

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