Editing Neurogenic LUT Dysfunction (section)

=== Diabetes ===
* Most common cause of peripheral neuropathy in Europe and North America.
* 5-59% of patients with diabetes report symptoms of LUT dysfunction
* '''Diabetic cystopathy'''
** Term to describe the involvement of the LUT by this disease.
** '''Current evidence points to both a sensory and a motor neuropathy as being involved in the pathogenesis, with the motor aspect contributing to the impaired detrusor contractility'''
*** '''The classic description is that of a peripheral and autonomic neuropathy that first affects sensory afferent pathways, causing the insidious onset of impaired bladder sensation'''.
*** As the classic description continues, a gradual increase in the time interval between voiding results, which may progress to the point at which the patient voids only once or twice a day without ever sensing any real urgency. If this continues, detrusor distention, overdistention, and decompensation ultimately occur. '''Detrusor contractility, therefore, is classically described as being decreased in the end-stage diabetic bladder'''.
* '''Urodynamics'''
** '''More recently, detrusor overactivity has been cited as the most frequent urodynamic finding'''.
*** This could be a result of a difference in the time of diagnosis with reference to the natural history of the effects of diabetes on the LUT.
** '''Other classic urodynamic findings include impaired bladder sensation, increased cystometric bladder capacity, decreased bladder contractility, decreased flow, and, later, increased residual urine volume'''
** At least in men, the main differential diagnosis is bladder outlet obstruction, because both conditions commonly produce a low urinary flow rate; however, pressure-flow urodynamic studies easily differentiate the two.
** '''Smooth or striated sphincter dyssynergia usually is not seen in classic diabetic cystopathy'''
* '''Early institution of timed voiding will avoid some of the impaired detrusor contractility from chronic distention and detrusor decompensation. intensive therapy for diabetes can slow its progression and slow the development of abnormal autonomic tests.'''