The Tribune

By DR GREGGORY PINTO

There is a strong link between diabetes and many aspects of urological health.

Many urological issues for both men and women are related to undiagnosed or poorly controlled diabetes and to a lesser extent related to even well controlled diabetes.

The urological complications of diabetes include urinary tract infections, kidney stones, urinary incontinence, overactive bladder, kidney failure and sexual dysfunction.

An alarming one in seven Bahamian adults has diabetes or is pre-diabetic.

Diabetes mellitus is a condition that leads to high levels of glucose in the body. The main source of energy for the body is derived from glucose. The pancreas gland produces the hormone insulin, that is responsible for moving glucose from the blood and into the cells of the body. Diabetics lack insulin or have insulin that is unable to function properly and this results in too much glucose remaining in the blood, which could lead to the damage of many organs.

Kidney stones

High concentrations in urine of calcium, uric acid and oxalate can lead to kidney stone formation. Crystals of one or more of these elements can accumulate and lead to kidney stone formation.

Type 2 diabetics can have high levels of insulin that could lead to more acidic urine that could lead to uric acid stone formation in particular. Diabetic insulin resistance can lead to high concentrations of calcium in urine that could promote kidney stone formation.

The haemoglobin A1c blood test indicates a person’s average blood level over the previous two to three months. The HbA1c blood test is an important indicator of diabetic sugar control.

According to the European Urology journal, poorly controlled type 2 diabetics, with a HbA1c blood level of greater than 6.5 percent (upper limit of normal ) have a 92 percent greater risk of developing kidney stones. Well controlled type 2 diabetics with an HbA1c blood level that was in the normal range still had a 34 percent greater risk of developing kidney stones.

Diabetic cystopathy

Nearly half of diabetic men and women suffer from diabetic cystopathy, which is characterised by a poor bladder filling sensation, reduced ability of the bladder to contact and empty fully, increased bladder size and an increased volume of urine remaining in the bladder after attempts to empty completely.

Incomplete bladder emptying can lead to recurrent urinary tract infections, bladder stone formation, increased urinary frequency and urgency, urinary incontinence/leak and possible acute or chronic kidney failure.

Middle-aged men or older often suffer from urinary symptoms such as straining, dribbling urine, weak urinary stream and increased day and night time urinary frequency and urgency which is often the result of the benign enlargement of their prostate. Bladder dysfunction in diabetic men can mimic or exacerbate these same symptoms that are seen in men with benign prostate hyperplasia (BPH).

Sexual dysfunction

Diabetes mellitus often leads to some element of sexual dysfunction in both men and women.

Diabetic men often suffer from poor sexual libido, erectile dysfunction, retrograde/dry ejaculation and orgasmic dysfunction.

Approximately 35 to 75 percent of diabetic men will experience some form of erectile dysfunction in their lifetime. Diabetic men usually develop erectile dysfunction ten to fifteen years before their male counterparts without diabetes.

The causes of erectile dysfunction in diabetic men is multifactorial; involving nerve, blood supply and muscle dysfunctions. Diabetes can lead to damage of both the nerve supply and blood supply to the penis.

Women with diabetes also may suffer from reduced sexual desire, painful intercourse, orgasmic dysfunction, and diminished sexual arousal.

Urinary tract infections

Women who suffer from diabetes mellitus are unfortunately plagued far too often with recurrent urinary tract infections that could reduce the quality of their lives. Many scientific studies have concluded that women in particular with type 2 diabetes have increased risk of symptomatic urinary tract infections.

According to the American Diabetes Association, 9.4 percent of type 2 diabetics are afflicted with urinary tract infections, when compared to only 5.7 percent of non diabetics.

For postmenopausal women with diabetes there is an almost two fold increased risk for urinary tract infections.

Kidney failure

Diabetes mellitus is the most common cause of kidney failure.

Persistently high glucose levels in the blood can lead to damage to the kidneys, which is termed diabetic neuropathy.

Poorly controlled diabetes could cause injury to blood vessels in the kidneys, that could impair the kidney’s ability to function, which could lead to retention of water and salt and the build up of waste products.

Uncontrolled diabetes could damage nerves that could lead to incomplete bladder emptying and a subsequent back pressure on the kidneys that could result in kidney failure as well.

Approximately 30 percent of type 1 diabetics will suffer from some element kidney failure and 10 to 40 percent of type 2 diabetics will end up with kidney failure

There are varying stages of kidney failure and not all kidney failure patients require dialysis or a kidney transplant.

Well controlled diabetes mellitus and diabetes diagnosed early and treated appropriately could prevent the various complications of diabetes from occurring.

Many Bahamians are pre-diabetic and life style changes involving diet, exercise and weight loss could prevent the onset of diabetes mellitus.

Education is key in the effort to combat the scourge of poorly controlled and undiagnosed diabetes mellitus in the Bahamas.

• Dr Greggory Pinto is a board certified Bahamian urologist and laparoscopic surgeon. He has trained in Germany, South Africa and France, and is a member of the European Association of Urology. Please note that after July 1, Dr Pinto will no longer by at The Surgical Suite. Further details will follow.