Therapy insight: sexual and bladder dysfunction associated with diabetes mellitus

Diabetes mellitus affects 3-6% of the population. Patients with diabetes experience chronic vascular complications, which lead to a wide range of medical problems. Genitourinary problems are included among these complications, related to both neuropathy and vasculopathy. The most important clinical features relating to genitourinary involvement in patients with diabetes include erectile dysfunction (ED) and retrograde ejaculation in men, and bladder dysfunction. There is a 36% prevalence of ED in men with diabetes, which is about three times higher than in the general population. With so many other factors contributing to the risk of developing ED, it is important that men with diabetes are advised not only regarding glycemic control, but also in relation to lifestyle factors that might contribute to the development of ED, such as smoking. Diabetes-associated bladder dysfunction, characterized by decreased bladder sensation, increased bladder capacity, and impaired detrusor contractility, is another important condition to consider when treating patients with diabetes. Accurate assessment is important in these patients in order to reduce the damage associated with neurogenic bladder dysfunction. Management goals for these patients include voiding strategies for relief of symptoms, prevention and treatment of infections, continence, and adequate bladder emptying. This review discusses the mechanisms behind urologic conditions that are often encountered when treating patients with diabetes, and summarizes the evaluation and management of these patients.