Alejandro Roldán-Alzate

Normal voiding in both men and women is characterized by a symmetric and coordinated contraction of the detrusor with synchronous descent of the bladder base and funneling of the bladder neck. We postulate that diabetes-induced lack of coordination of the detrusor contraction and funneling of the bladder neck during voiding that occur early in the disease process are critical factors in development of voiding symptoms and impaired bladder emptying. These changes would not have been identified previously, since multichannel pressure-flow studies lack dynamic 3-dimensional imaging of the bladder and outlet during voiding. Pressure-flow studies do not fully characterize the voiding biomechanics and only report the net effects in terms of bladder pressure and urine flow. We 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 postulate that this will demonstrate asymmetric and uncoordinated contraction of the detrusor as well as asynchronous or incomplete descent of the bladder base and funneling of the bladder neck as compared to age- matched healthy 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 development and use of interventions to prevent clinical progression. Based on neurophysiologic voiding studies in diabetic animal models and our ongoing studies of human volunteers, we hypothesize that impaired coordination of the detrusor contraction and asynchronous or incomplete descent of the bladder base and funneling of the bladder neck are early features of diabetic bladder dysfunction in both men and women.