Hyposensitivity of C-fiber afferents at the distal extremities as an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women
Journal
PLoS ONE
Journal Volume
9
Journal Issue
1
Pages
e86463
Date Issued
2014
Author(s)
Abstract
Purpose: To investigate the relationship between distal symmetric peripheral neuropathy and early stages of autonomic bladder dysfunction in type 2 diabetic women. Materials and Methods: A total of 137 diabetic women with minimal coexisting confounders of voiding dysfunction followed at a diabetes clinic were subject to the following evaluations: current perception threshold (CPT) tests on myelinated and unmyelinated nerves at the big toe for peroneal nerve and middle finger for median nerve, uroflowmetry, post-void residual urine volume, and overactive bladder (OAB) symptom score questionnaire. Patients presenting with voiding difficulty also underwent urodynamic studies and intravesical CPT tests. Results: Based on the OAB symptom score and urodynamic studies, 19% of diabetic women had the OAB syndrome while 24.8% had unrecognized urodynamic bladder dysfunction (UBD). The OAB group had a significantly greater mean 5 Hz CPT test value at the big toe by comparison to those without OAB. When compared to diabetic women without UBD, those with UBD showed greater mean 5 Hz CPT test values at the middle finger and big toe. The diabetic women categorized as C-fiber hyposensitivity at the middle finger or big toe by using CPT test also had higher odds ratios of UBD. Among diabetic women with UBD, the 5 Hz CPT test values at the big toe and middle finger were significantly associated with intravesical 5 Hz CPT test values. Conclusions: Using electrophysiological evidence, our study revealed that hyposensitivity of unmyelinated C fiber afferents at the distal extremities is an indicator of early stages diabetic bladder dysfunction in type 2 diabetic women. The C fiber dysfunction at the distal extremities seems concurrent with vesical C-fiber neuropathy and may be a sentinel for developing early diabetic bladder dysfunction among female patients. ? 2014 Lee et al.
SDGs
Other Subjects
adult; article; bladder dysfunction; controlled study; current perception threshold test; female; finger; hallux; human; major clinical study; median nerve; micturition disorder; myelinated nerve; non insulin dependent diabetes mellitus; nonmyelinated nerve; overactive bladder; peripheral neuropathy; peroneus nerve; questionnaire; residual urine; sensory nerve; sensory system examination; uroflowmetry; Afferent Pathways; Aged; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Electric Stimulation; Female; Fingers; Humans; Middle Aged; Nerve Fibers, Unmyelinated; Perception; Toes; Urinary Incontinence
Publisher
Public Library of Science
Type
journal article