Wade Bushman

Lower urinary tract dysfunction is common in patients with diabetes. Our research addresses two important knowledge gaps. The first is that the changes in bladder voiding function that occur early in the development of diabetic cystopathy in humans has never been comprehensively studied. The second is that the effect of diabetes on coordination of the voiding reflex has never been examined. We postulate that diabetes-induced dyscoordination of the detrusor contraction and impaired relaxation of the bladder outlet during voiding are critical factors in development of voiding symptoms and impaired bladder emptying. We will use a recently developed MRI-based non-invasive dynamic imaging protocol to image the bladder and outlet during voiding in young adult men and women with type 1 diabetes to assess symmetry of the detrusor contraction and coordination with opening of the bladder outlet. We predict that this will demonstrate asymmetric and uncoordinated contraction of the detrusor and delayed or incomplete opening of the bladder outlet as compared to age-matched normal controls. We expect our studies to yield a comprehensive evaluation of early stages of diabetic bladder dysfunction, reveal a heretofore unknown feature of that dysfunction and inform the use of established medical interventions to prevent clinical progression.