Treatment of diabetic cystopathy

Neurogenic bladder disorders in diabetic patients may result in insufficient bladder emptying because of loss of reflex detrusor contraction. In those who are asymptomatic or have only moderate signs of diabetic cystopathy, treatment choices are scheduled voiding by the triple-voiding technique, cholinergic treatment either daily or twice weekly, and transurethral surgery of the bladder neck. In patients with total urine retention, an indwelling catheter will decrease the overstretched detrusor muscle. Cholinergic treatment with initially high parenteral doses of bethanecol may help to diminish residual urine. Transurethral surgery is often mandatory in such cases. Decensus of the bladder in females often requires surgery. Deficient bladder sensation is irreversible in diabetics, and follow-up of treatment should be lifelong.