- Original article
- Published:
Evaluation of different electrophysiological studies in the detection of urinary and sexual dysfunction in diabetic women
Egyptian Rheumatology and Rehabilitation volume 40, pages 39–49 (2013)
Abstract
Background
Diabetes mellitus is the most common cause of urinary and sexual dysfunction. Although diabetes mellitus can be diagnosed clearly and simply, diabetic neuropathy and diabetic cystopathy (DC) can progress insidiously over time without any symptoms, manifesting itself at a later stage, which increases the risk of secondary complications. Therefore, early diagnosis in the asymptomatic stage of DC with a simple noninvasive method is of utmost importance.
Aim of the work
To evaluate the different electrophysiological studies [including genital sympathetic skin response (SSR), somatosensory-evoked potential (SSEP) of the tibial nerve] in the early detection of urinary and sexual dysfunction in diabetic women.
Patients and methods
This study was carried out on 30 diabetic women and 10 healthy women served as a control group. All patients were divided into two groups (group I and group II) with respect to lower urinary tract symptoms and signs. They were subjected to a full assessment of medical history, full neurological examination, and assessment by the female sexual function index questionnaire. Urodynamic studies including: uroflowmetry and cystometry were carried out for all patients. Electrophysiological studies were carried out for both patients and controls and included nerve conduction studies of both tibial and peroneal nerves, sensory nerve conduction studies of both sural nerves, SSEP of the tibial nerve and genital, hand, and foot SSR.
Results
In group I: Abnormal findings of motor studies were recorded in 1/15 (6.6%) patients, prolonged genital SSR in one patient (6.6%) and absent in two patients 2/15 (13.3%). Prolonged SSEP were recorded in 2/15 (13.3%) of patients. As regards urodynamic study, abnormal findings were detected in 3 patients (20%). In group II: Abnormal findings of motor studies were recorded in 8/15 (53.3%) patients, absent foot SSR in four patients (26.6%), absent genital SSR in seven (46.6%) patients. Prolonged SSEP P40 were recorded in 6/15 (40%). As regards urodynamic study, abnormal findings were detected in 12 patients (80%). There was statistically significant difference between both groups as regards all electerophysiologic parameters except foot latency. There was a statistically highly significant difference between urodynamic diagnosis and genital SSR and SSEP P40 of tibial nerve.
Conclusion
Although urodynamic is essential for the actual diagnosis and the detection of variable pathophysiological changes, electrophysiological studies represent an easy, valid, and noninvasive objective method for the evaluation of DC and sexual dysfunction.
References
Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008; 120:1–34.
Koubaa S, Ben Salah FZ, Miri I, Ghorbel S, Lebib S, Dziri C, Rokbani L. Neurogenic bladder in diabetes mellitus. Tunis Med 2009; 87: 279–282.
Burakgazi AZ, Alsowaity B, Burakgazi ZA, Unal D, Kelly JJ. Bladder dysfunction in peripheral neuropathies. Muscle Nerve 2012; 45:2–8.
Gomez CS, Kanagarajah P, Gousse AE. Bladder dysfunction in patients with diabetes. Curr Urol Rep 2011; 12:416–426.
Yenilmez A, Kebapci N, Isikli B, Hamarat M, Donmez T. Morbidity after urodynamic study in diabetic patients. Acta Diabetol 2008; 46:197–202.
Weiss L, Silver J, Weiss J. Easy EMG. A guide to performing nerve conduction studies and electromyography. Butterworth- Heinemann/Elsevier Inc.; 2004.
Soliman E. 2005. Diabetic neuropathy. [cited March 27, 2012]; Available athtpp//www.emedicine-diabeticneuropathyarticlebyEmadsoliman,MD,Msc.htm. [Accessed 1 July 2012].
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2006; 29:543–548.
Abrams B, Cardozo L, Fall M. The standardization of terminology of lower urinary tract function. Neurourol Urodyn 2002; 21:167–178.
Rosen R, Browen C, Leiblum S, Meston C, Shabsigh R, Ferguson D, Dagostino R. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26:191–208.
Kucera P, Goldenberg Z, Kurca E. Sympathetic skin response: review of the method and its clinical use. Bratisl Lek Listy 2004; 105:108–116.
Pfisterer MH, Griffiths DJ, Rosenberg L, Schaefer W, Resnick NM. Parameters of bladder function in pre-, peri- and postmenopausal continent women without detrusor overactivity. Neurourol Urodyn 2007; 26:356–361.
Daneshgari F, Liu G, Birder L, Hanna-Mitchell AT, Chacko S. Diabetic bladder dysfunction: current translational knowledge. J Urol 2009; 182 (6 Suppl): S18–S26.
Rapidi CA, Karandreas N, Katsifotis C, Benroubi M, Petropoulou K, Theodorou C. A combined urodynamic and electrophysiological study of diabetic cystopathy. Neurourol Urodyn 2006; 25:32–38.
Soylu A, Akinci A, Yilmaz U, Sarier M, Aslan M, Ozcan C. Sympathetic skin responses in type-1 diabetic children: relationship to urodynamic findings. Neurourol Urodyn 2006; 25:243–248.
Kebapci N, Yenilmez A, Efe B, Entok E, Demirusutu C. Bladder dysfunction in type 2 diabetic patients. Neurourol Urodyn 2007; 26:814–819.
Esteghamati A, Rashidi A, Nikfallah A, Yousefizadeh A. The association between urodynamic findings and microvascular complications in patients with long-term type 2 diabetes but without voiding symptoms. Diabetes Res Clin Pract 2007; 78:42–50.
Bansal R, Agarwal MM, Modi M, Mandal AK, Singh SK. Urodynamic profile of diabetic patients with lower urinary tract symptoms: association of diabetic cystopathy with autonomic and peripheral neuropathy. Urology 2011; 77:699–705.
Gerstenberger EP, Rosen RC, Brewer JV, Meston CM, Brotto LA, Wiegel M, Sand M. Sexual desire and the female sexual function index (FSFI): a sexual desire cutpoint for clinical interpretation of the FSFI in women with and without hypoactive sexual desire disorder. J Sex Med 2010; 7:3096–3103.
Takahashi M, Inokuchi T, Watanabe C, Saito T, Kai I. The female sexual function index (FSFI): development of a Japanese version. J Sex Med 2011; 8:2246–2254.
Abu Ali RM, Al Hajeri RM, Khader YS, Shegem NS, Ajlouni KM. Sexual dysfunction in Jordanian diabetic women. Diabetes Care 2008; 31: 1580–1581.
Esposito K, Maiorino MI, Bellastella G, Giugliano F, Romano M, Giugliano D. Determinants of female sexual dysfunction in type 2 diabetes. Int J Impot Res 2010; 22:179–184.
Wallner LP, Sarma AV, Kim C. Sexual functioning among women with and without diabetes in the Boston Area Community Health Study. J Sex Med 2010; 7:881–887.
Fatemi SS, Tachavi SM. Evaluation of sexual function in women with type 2 diabetes mellitus. Diabetes Vasc Dis Res 2009; 6:38–39.
Secil Y, Özdedeli K, Altay B, Aydog˘ du I, Yilmaz C, Ertekin C. Sympathetic skin response recorded from genital region in normal and diabetic women. Neurophysiol Clin 2005; 35:11–17.
Sec¸il Y, Yetimalar Y, Gedizlioglu M, Arpaci E, Tokuc¸oglu F, Inceoglu Kendir A, et al. Sexual dysfunction and sympathetic skin response recorded from the genital region in women with multiple sclerosis. Mult Scler J 2007; 13: 742–748.
Kaplan SA, Blaivas JG. Urodynamic findings in patients with diabetic cystopathy. J Urol 1995; 153:342–344.
Rodic B, Curt A, Dietz V, Schurch B. Bladder neck incompetence in patients with spinal cord injury: significance of sympathetic skin response. J Urol 2000; 163:1223–1227.
Ueda T, Yoshimura N, Yoshida O. Diabetic cystopathy: relationship to autonomic neuropathy detected by sympathetic skin response. J Urol 1997; 157:580–584.
Podnar S. Neurophysiology of the neurogenic lower urinary tract disorders. Clinl Neurophysiol 2007; 118:1423–1437.
McGuire EJ, Shi-Chun Z, Horwinski ER. Treatment of motor and sensory detrusor instability by electrical stimulation. J Urol 1982; 129:78–79.
La Portilla F, Rada R, Vega J, Gonzalez CA, Cisneros N, Maldonado VH. Evaluation of the use of posterior tibial nerve stimulation for the treatment of fecal incontinence: preliminary results of a prospective study. Dis Colon Rectum 2009; 52:1427–1433.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
El Hefnawy, H.E.S., El Arousy, N.H., Shaker, H.S. et al. Evaluation of different electrophysiological studies in the detection of urinary and sexual dysfunction in diabetic women. Egypt Rheumatol Rehabil 40, 39–49 (2013). https://doi.org/10.7123/01.ERR.0000428090.79340.78
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.7123/01.ERR.0000428090.79340.78