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Diabetic cystopathy — SCE Endocrinology MCQ

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HardDiabetes complicationsDiabetic cystopathySCE Endocrinology

A 64-year-old woman with long-standing diabetes has recurrent urinary tract infections and overflow incontinence. Post-void bladder volume is 650 ml and she has reduced foot sensation with postural hypotension. What is the most likely diagnosis?

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Correct answer: C — Diabetic autonomic cystopathy

Diabetic autonomic cystopathy is best because large post-void residual volume with other autonomic neuropathy features suggests diabetic bladder dysfunction. The alternatives are less appropriate because aldosteronism causes hypertension and hypokalaemia; cranial DI causes polyuria not retention; stress incontinence has low residuals; hypercalcaemic nephrogenic DI would not cause retention. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG28; urology guidance