DIABETES AND THE UROLOGISTArch Enemies!

Dr. Kenneth Thomas, MDDiabetes Support Group

Starkville, MS7/10/12

Introduction

25.8 million children and adults in the United States—8.3% of the population—have diabetes

10.9 million, or 26.9% of all people in the 65+ age group have diabetes

Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes!

Introduction

Other Problems Heart disease Stroke Neuropathy Blindness High blood pressure Amputation Elevated lipid profiles

Introduction

What we’ll talk about Bladder Dysfunction – Anything from “I

pee too much” to “I can’t pee” Urinary Incontinence BPH – older gentlemen with difficulty

voiding UTIs ED

Introduction

What we’ll talk about Hypogonadism – “Low T” Diabetic Nephropathy – fancy words for

the kidneys not working like they used to Renal Transplantation Surgery

Bladder Dysfunction

Over half of diabetics have bladder “issues”

Diabetic Cystopathy – poor bladder sensation, poor contractility and increased post-void residuals (increased incidence the longer a patient has had DM)

39-61% of patients have urgency +/- frequency

Bladder Dysfunction

What can diabetic cystopathy (elevated residuals) lead to? UTIs Vesicoureteral reflux and hydronephrosis Kidney damage Kidney stones sepsis

Bladder Dysfunction

What can we do?! Urodynamics Conservative (pelvic floor training,

intermittent catheterization) Pharmacological Surgical

Urinary Incontinence

Almost double the risk compared to those without DM

Can be 3 different types of incontinence Urge Stress Overflow

Urinary Incontinence

Treatments? Weight loss and DM control Conservative (Kegels, etc) Pharmacological Surgical

BPH

There is a direct relationship between prostate growth and DM/obesity

How does this work?? …We don’t really know

UTIs

Double the risk (in postmenopausal women with DM)

If taking DM meds, triples or quadruples the risk!

Sometimes the kidney also is infected (pyelonephritis) possibly leading to decreased renal function

UTIs

Can also lead to renal abscesses or papillary necrosis

Treatments Prophylaxis or intermittent treatment DM control Estrogen Yogurt, cranberry juice Low post-void residuals

ED

Risks factors DM Obesity High blood pressure Lipid disorders Smoking Heart disease

ED

20-71% of patients with DM have ED

Smoking doubles the risk

The worse the DM, the worse the ED

ED

Treatments Meds Intraurethral pellet Injections Penile Pump Penile Prosthesis

Hypogonadism

Low T can be a predictor of upcoming DM!

Testosterone decreases with obesity and age

Testosterone replacement can improve sensitivity to insulin

It has also been shown to actually delay the progression of DM, the metabolic syndrome, ED, and voiding dysfunction

Diabetic Nephropathy

Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008

In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States

20-30% of people with DM will be affected by this

Diabetic Nephropathy

If creatinine is above 1.5, there’s a linear increase in morbidity and mortality (age is the best independent predictor long term)

Can ultimately lead to end-stage renal failure…which leads to worsening cardiovascular disease

Treatments Hemodialysis Peritoneal dialysis Kidney transplant

Renal Transplantation

16% of DM patients on HD ultimately undergo renal transplant

Selection criteria Age < 65 No cardiovascular or cerebrovascular

disease No sepsis No “life-limiting” comorbidity

On the rise – simultaneous kidney and pancreas transplant

Surgery

DM is the most common surgical endocrinopathy

Optimize glucose control (affects postop outcomes)

Summary

Diabetes is our enemy! Better control means better

outcomes and slowing the progression down

Team approach – family physician, support groups, dieticians, etc

“Am I part of the cure or am I part of the disease?” - Coldplay

Questions/Comments

References

American Diabetes Association “Diabetes and the urologist: a

growing problem”, Goldstraw, BJU International, 2006.