How Diabetes Affects Urological Health

10 Jun 2019 Blog

Did you know a common symptom of undiagnosed diabetes is frequent urination? This is because of the urine-producing effect of glucose in the urine. People with urinary frequency will often consult a urologist in error, thinking that the problem is related to their kidneys, bladder or prostate, when it’s actually the sugar in the urine that’s causing the problem. Because of this urinary frequency, urologists often have the opportunity to make the initial diabetes diagnosis and refer the patient for appropriate care.
Diabetes has harmful effects on all body systems, including urological health. Many urological problems occur as a result of diabetes, including urinary infections, kidney and bladder conditions, foreskin issues and sexual problems. Additionally, diabetes increases the risk of kidney stones.

What is diabetes?

Diabetes is a disease in which blood glucose levels are elevated. Glucose is the body’s main fuel source, derived from the diet.  Insulin, a hormone secreted by the pancreas, is responsible for moving glucose from the blood into the body’s cells. In diabetes, either there is no insulin, or alternatively, plenty of insulin, but the body cannot use it properly. Without functioning insulin, the glucose stays in the blood and not the cells that need it, resulting in potential harm to many organs.

Two distinct types of diabetes exist. Type 1 is an autoimmune condition in which the body’s immune system destroys insulin-producing cells, severely limiting or completely stopping all insulin production. It is often inherited and is responsible for about 5% of diabetes. It is managed by insulin injections or an insulin pump.

Type 2 diabetes is caused by overeating and sedentary living and is responsible for 95% of diabetes. This form of diabetes is caused by insulin resistance, a condition in which the body cannot process insulin and is resistant to its actions. Type 2 diabetes is a classic example of an avoidable and “elective” chronic disease that occurs because of an unhealthy lifestyle.

Common symptoms of diabetes are frequent urination, thirst, extreme hunger, weight loss, fatigue and irritability, recurrent infections, blurry vision, cuts that are slow to heal, and tingling or numbness in the hands or feet.

How does diabetes affect the bladder?

Many diabetics have urological problems that affect the bladder. A common problem is impaired sensation in which the bladder becomes “numb” and the patient gets no signal to urinate. Another problem is impaired bladder contractility in which the bladder muscle does not function properly, causing an inability to empty the bladder completely. Other diabetics develop involuntary bladder contractions, or overactive bladder, causing urinary urgency, frequency and incontinence.

How does diabetes affect the kidneys?

Diabetes is the most common cause of kidney failure, accounting for almost half of all new cases. Even with diabetic control, the disease can lead to chronic kidney disease, kidney failure and the need for dialysis or kidney transplantation.

How does diabetes affect the urinary tract and genitals?

Diabetics have more frequent urinary tract infections because of factors including improper functioning of the infection-fighting white blood cells, glucose in the urine, and compromised blood flow. Diabetics have a greater risk of asymptomatic bacteriuria and pyuria (the presence of white cells and bacteria in the urine without infection), cystitis (bladder infections), and pyelonephritis (kidney infections).

Impaired bladder emptying further complicates the potential for infections. Diabetics have more serious complications of pyelonephritis, including kidney abscess, emphysematous pyelonephritis (infection with gas-forming bacteria), and urosepsis (a very serious systemic infection originating in the urinary tract requiring hospitalization and intravenous antibiotics).

Fournier’s gangrene (necrotizing fasciitis) is a soft tissue infection of the male genitals that often requires emergency surgery, can be disfiguring and has a very high mortality rate. More than 90% of patients with Fournier’s gangrene are diabetic. Diabetic patients also have an increased risk of infection with surgical procedures, particularly those involving prosthetic implants, including penile implants, artificial urinary sphincters, and mesh implants for pelvic organ prolapse.

How does diabetes affect the foreskin?

Balanoposthitis is medical speak for inflammation of the head of the penis and foreskin. As mentioned previously, a tight foreskin that cannot be pulled back to expose the head of the penis (phimosis) can be the first clinical sign of diabetes in uncircumcised men. At least 25% of men with this problem have underlying diabetes. It is common for these men to have fungal infections under the foreskin because of the risk factors of a warm, moist, dark environment in conjunction with the presence of glucose in the urine. The good news is that phimosis and fungal infections often respond well to diabetic control.

How does diabetes affect sexual function?

Sexual functioning is based upon good blood flow and an intact nerve supply to the genitals and pelvis. Diabetics often develop sexual problems (in fact, diabetes is the most common cause of erectile dysfunction) because of the combination of neuropathy and blood vessel disease. Men commonly have a reduced sex drive and have difficulty achieving and maintaining erections.

Diabetes increases the risk of erectile dysfunction threefold. Diabetes has clearly been linked with testosterone deficiency, which can negatively impact sex drive and sexual function. Because of the neuropathy, many diabetic males have retrograde ejaculation, a situation in which semen goes backwards into the bladder and not out the urethra. Female diabetics are not spared from sexual problems and commonly have reduced desire, decreased arousal and sexual response, vaginal lubrication issues and painful sexual intercourse.

How is diabetes managed?

With Type 2 diabetes, it’s vital to modify lifestyle, including dietary changes that avoid diabetic-promoting foods and replacement with healthier foods in order to have appropriate sugar control to help prevent diabetic complications. Diabetics should refrain from high glycemic index foods (those that are rapidly absorbed) including sugars and refined white carbohydrates. Instead, diabetics should consume high-fiber vegetables, fresh fruits, and whole-grain products. Regular exercise is equally as important as healthy eating, and the combination of healthy eating, physical activity, and weight loss can often adequately address Type 2 diabetes.

When lifestyle measures cannot be successfully implemented or do not achieve complete resolution, there are different classes of medications that can be used to manage the diabetes. However, lifestyle modification should always be the initial approach, since lifestyle (in large part) caused the problem and is capable of improving/reversing it. At times, when diet, exercise and drugs are unable to control the diabetes, bariatric (weight loss) surgery may be needed to control and even potentially eliminate the diabetes.

Written by Dr. Andrew Siegel

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