Diabetes and voiding disorders.

Diabetic neuropathy of can induce multi-organ dysfunction. The diabetes sim ultaneously has profound repercussions on gastrointestinal, sexual and erec tile functions. One of the main sequelae of diabetic neuropathy is autonomi c neuropathy affecting the vesicosphincteric control. The objective of this study was to review the epidemiological, clinical, laboratory and therapeu tic data concerning voiding disorders observed in diabetes. Although the th erapeutic management of an isolated voiding disorder in diabetics still rem ains symptomatic, it raises aetiological problems due to the comorbidity, p articularly prostatic obstructive syndromes in men, pelvic dysfunction in w omen and ageing. Diabetic patients in renal failure also present specific v esicosphincteric disorders which are reviewed. Diabetic patients should be more systematically screened for the development of diabetic bladder diseas e, especially for associated factors which participate in its clinical expr ession. This implies extreme caution in the management of benign prostatic hyperplasia in the case of comorbidity, to avoid deteriorating a sometimes fragile detrusor-sphincter equilibrium. Diabetic detrusor hyperactivity mus t be better known in order to be more effectively detected. Pharmacological treatment of this condition raises problems related to detrusor hypocontra ctility also related to diabetic bladder disease. Clinical examination shou ld be able to select those patients requiring further urodynamic studies in order to assess the individual detrusor-sphincter equilibrium. These inves tigations are required when surgical treatment of an associated urological or gynaecological disorder is considered.