Die diabetische Zystopathie - eine Standort-bestimmung - Wissenschaftlicher Kenntnisstand noch immer überraschend unscharf

Der wissenschaftliche Kenntnisstand über die diabetische Zystopathie ist in Anbetracht der Prävalenz und volkswirtschaftlichen Bedeutung dieser Folgeerkrankung eines Diabetes mellitus immer noch überraschend unscharf. Zeichen einer diabetischen Blasenstörung entwickelt nahezu jeder zweite Diabetiker - abhängig von der Latenz des Diabetes mellitus. Sowohl die Entwicklung einer überaktiven Blase als auch einer hypokontraktilen Blase ist möglich. Die zugrunde liegenden pathophysiologischen Vorgänge betreffen die Eigenschaften der Detrusormuskulatur unter den Bedingungen oxidativen Stresses, die cholinerge, purinerge und endothelinrezeptorvermittelte Innervation, die muskarinergen Rezeptorsubtypen, Stickoxid als Mediator, die Natriumpumpe, Prostaglandine, den „nerve growth factor” (NGF) und andere Faktoren. Therapeutische Ansätze für eine gezielte Therapie der diabetischen Zystopathie sind rar und im Experimentalstadium. Während - wie für alle Diabetes-Folgeerkrankungen bewiesen - eine optimale Blutzuckereinstellung günstige Effekte hinsichtlich der Progredienz der Erkrankung zu zeigen scheint, liegen lediglich tierexperimentelle Untersuchungen zum Beispiel über gentechnische Ansätze zur Substitution des „nerve growth factors” vor.

The knowledge of the diabetic cystopathy in relation to the prevalence and cost of the health care system are still unclear. Every second patient with diabetes mellitus develops signs of diabetic urinary bladder symptoms. Both the symptoms of over- and hypo-activity are possibly based on pathological changes which are based on different levels: they influence the smooth muscle of the detrusor in situations of oxidative stress, cholinergic, purineric innervations through the receptors of the endothelium, muscarinic sub-receptors, NOS as a mediator, sodium pump, prostaglandine, nerve growth factor (NGF), and other factors. There are very few therapeutic approaches that target the treatment of diabetic cystopathy. Whereas with experimental, as with all other diabetic side effects, optimum blood sugar adjustment has the best possibility to influence to prognosis. However, only experimental genetic approaches using NGF substitution are published.

Key words

diabetes - diabetic cystopathy - lower urinary tract symptoms - urodynamics - detrusor dysfunction

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