Clinical Study On Warming Kidney And Activating Yang Method Treating Female Diabetic Neurogenic Bladder

Purpose:To study the efficacy of traditional Chinese medicine of warming the kidney and activating yang method for diabetic neurogenic bladder in female with type 2 diabetes mellitus. The clinical symptoms of insufficiency of kidney-YANG, America urological association lower urinary symptom score index, impact of urinary symptoms against quality of life was evaluate. The urodynamic study data including maximum flow rate, residual urine, and first sensation in filling phase, post-voiding residual urine volume, urinary bladder capacity, maximum detrusor pressure and voiding efficacy was collected. The level of serum glycated hemoglobin Alc, total cholesterol and triglycerol were also determined for the difference between control group(western medicine group) and study group(Chinese medicine and western medicine combine treatment group) was compared.Methods:A randomized, controlled trial was conducted in 60 patients with type 2 diabetes mellitus associated with insufficiency of kidney-YANG. The patients were randomly classified into two groups. Based on ordinary treatment and diet control, the control group (n=31) was treated by tamsulosin orally (0.2mg daily) and urecholine (75 mg daily, divided in three doses).The control group (n=29) was treated by tamsulosin orally (0.2mg daily) and urecholine (75 mg daily, divided in three doses) and Bawei Di Huang Wan (12 gm daily, divided in three doses). The treatment course was 12 weeks. The symptom of insufficiency of kidney-YANG, lower urinary tract symptoms, impact of quality of life by lower urinary tract symptoms was evaluated with questionnaires. The standard videourodynamic study was performed and parameters were recorded. The serum levels of glycated hemoglobin A1C, total cholesterol, triglycerol were also recorded before and after trial. All the data was managed by the SPSS 15.0 statistics software for statistically significance between groups.Results:Before trial, age, disease course, clinical symptoms of insufficiency of kidney-YANG, lower urinary tract symptom score, impact of quality of life, parameters of urodynamic study, serum level of glycated hemoglobin, total cholesterol, triglycerol showed no statistical differences(P<0.05). The total effective rate in clinical symptoms of insufficiency of kidney-YANG of study group was 89.66%, while the control group was 25.80%. The study group had an advantage than the control group (P<0.05). In terms of lower urinary tract symptoms (AUA-SI) and quality of life, there was improvement in the study group (P<0.05). The study group had significant advantage on the lower urinary tract symptoms (AUA-SI) and quality of life over control group (P<0.05). The urodynamic parameters including maximum urinary flow rate, post-voiding residual volume, first sensation of cystometry, voiding efficacy improved significantly in study group. But bladder capacity, maximum detrusor pressure have no difference after trial (P>0.05). The study group also gained advantage in improvement of maximum urinary flow rate, post-voiding residual volume, first sensation of cystometry, voiding efficacy in comparison with control group (P<0.05). It showed Bawei Di Huang Wan is effective in treating the diabetic nurogenic bladder. The serum level of glycated hemoglobin A1C, total cholesterol, triglycerol lowered after treatment in study group (P<0.05) but not in control group (P>0.05). We concluded that Bawei Di Huang Wan may have advantage in blood sugar and better hyperlipidemia control in diabetic neurogenic bladder patients.Conclusion:This randomized control study showed that the method of warming the kidney and activating yang of traditional Chinese medicine combine with alpha blockers and cholinergic agents may have synergic effect in treating diabetic neurogenic bladder patients. However, the case number and period of present study is limited, further large scale, long term, multiple centers clinical trial is necessary to clarify the effectiveness and mechanism of Bawei Di Huang Wan for treating lower urinary tract dysfunction in diabetic patients.