Pathogenetic basis for the development of diabetic cystopathy

This article is devoted to the grounds of the development of the diabetes mellitus complications with regard to the lower urinary tract, namely to diabetic cystopathy. Symptoms and clinical signs of the diabetic cystopathy are presented in the wide spectrum from the frequency disorders to urinary incontinence and urinary retention. The diversity of the diabetes related micturition disturbances is mirroring the heterogeneity of the pathogenetic factors. The main factor is considered to be the diabetic angiopathy. The latter leads to the innervation disturbances in the urinary bladder, to the ischemia of the bladder wall, detrusor and urothelium dysfunction. Negative influence of the diabetic angiopathy is multiplied by the increased hyperosmolar diuresis and developing metabolic disturbances. Diabetic angiopathy is accompanied with the damage of the small vessels, supplying the nerve fibers - vasa vasorum and leads to the impairment of both afferent and efferent fibers. At that, the nerve growth factor synthesis is alternated in the bladder, demyelination and axonal degeneration occur in the efferent nerve fibers, resulting in the partial autonomous denervation of the urinary bladder. At the same time the activation and rise of the M2-cholinergic receptors density in the detrusor are present during the diabetic cystopathy. In general, diabetic cystopathy could be regarded as one of the types of neurogenic dysfunction. At that, all disturbances are happen in two stages - firstly, increase, and then decrease in the contractile function of the detrusor and sensitivity of the bladder. This sequence is linked to the exhaustion of the compensatory function of the urinary bladder and similar to the alterations in the bladder occurring during infravesical obstruction.