الفهرس | Only 14 pages are availabe for public view |
Abstract Diabetic autonomic neuropathy affecting the urogenital tract includes diabetic cystopathy and complex sexual functional disturbances in women including loss of libido as well as the inability to become aroused, the absence of orgasm or Dyspareunia. Diabetic cystopathy can progress insidiously over the time without any symptoms, manifesting itself at a later stage. This insidious progress increases the risk of secondary complications. Therefore, early diagnosis in the asymptomatic stage of diabetic cystopathy with simple non invasive method is of utmost importance. This study was carried out to evaluate the different electrophysiological studies (including genital sympathetic skin response, somatosensory evoked potential of tibial nerve) in early detection of urinary and sexual dysfunction in diabetic female in relation to urodynamic study and female sexual dysfunction index questionnaire (FSFI). We conducted our study on 30 diabetic females and 10 healthy subjects who served as a control group. All patients were stratified into two groups according to LUTS and LUTD and then subjected to history taking, FSFI questionnaire and clinical examination with special emphasis on pelvic neurological examination. For diagnosis of diabetic bladder dysfunction all patients were subjected to urodynamic studies which showed different pathophysiological findings. Electrophysiological studies were done for all patients included: 1. Motor nerve conduction of tibial and common peroneal nerve. 2. Sensory nerve conduction of sural nerve 3. Sympathetic skin response (SSR) of genital, hand, foot 4. Somatosensory evoked potential of tibial nerve. Our study revealed: 1. Statistically high significant between urodynamic study and genital SSR. 2. Statistically significant between urodynamic study and SSEP P40 of tibial nerve. 3. Sural nerve had high sensitivity and specificity in early stages and low specificity in late stages of diabetic bladder dysfunction. Our results showed that all parameters of urodynamic study had no significant correlation with electrophysiological except for residual urine volume which had significant correlation with SSEP of tibial and high significant correlation with genital SSR in both groups of patients. As regards sexual function assessment there was a statistically high significant correlation with genital SSR in both groups of patients. To sum up, diabetic bladder dysfunction (diabetic cystopathy) might be presented with different clinical pictures; classical presentation was rare; although urodynamic study is essential for actual diagnosis and detection of variable pathophysiological changes; Electrophysiological studies especially genital SSR and SSEP P40 of tibial nerve abnormalities raise the possibility of having DBD and draw our attention for further evaluation at early stages of DBD. |