Any clinician who’s interacting with a patient with diabetes, it could be a nutritional expert, it could be an advanced practise provider, a physician, they should ask their patients about their urinary and sexual symptoms because they’re highly prevalent in the general population as well, and they happen earlier in diabetes and they tend to be more severe. I’m Hunter Wessells. I’m a urologist at the University of Washington where I’m a professor. I’m also a member of the Diabetes Research Centre there. And I’ve had a longstanding research focus on urologic complications of diabetes. Interestingly, in prior eras when there were so many other complications like blindness, amputation, and kidney failure, these weren’t as important. But now that patients with diabetes are living longer, they’re suffering different complications. Actually somewhere between 30 and 40 % of men with diabetes will have erectile dysfunction. A similar number may have ejaculatory dysfunction. Maybe 25 % have significant urinary symptoms. And for women over 40 % will have sexual dysfunction. Somewhere in the 35 % will have urinary incontinence or significant bladder symptoms. And a smaller number will have UTIs and things like that. If you look at, probably a third have one complication, a third will have two and then a number will have three or even four complications. So, they travel together, and that relates to their mechanism, which is often driven by autonomic nerve dysfunction. I’d say any clinician who’s interacting with a patient with diabetes, it could be a nutritional expert, it could be an advanced practise provider, a physician, they should ask their patients about their urinary and sexual symptoms because they’re highly prevalent in the general population as well, and they happen earlier in diabetes and they tend to be more severe. So, asking the question. Well, the symptoms and signs are going to be somewhat common to a number of different diagnoses. It could be diabetic bladder dysfunction. In a man, it could be prostate enlargement and obstruction. And so, there is some overlap and nuance, but seeking to understand whether they’re symptoms is the first step. And the physical exam is important, but not as important as asking the question. Well, that’s the thing, we don’t have state of the art yet. We don’t have specific medications for diabetes-associated complications. But there are plenty of treatments out there for general treatment of sexual dysfunction or urinary symptoms. So, in men we have things like PDE5 inhibitors. In women, there’s one agent that’s approved by the FDA for female sexual dysfunction. And then, we have a lot of drugs for bladder dysfunction. And we also have less invasive options like pelvic floor physical therapy, behavioural training, and more invasive things like botox injections into the bladder if the overactivity is severe. So, we need to do a formal work-up and there’s one test that’s probably really important in the patient with diabetes and bladder symptoms. It’s making sure their bladder is emptying completely, because if it’s not, that could be a sign of more of a late-stage problem, which fortunately is very uncommon nowadays. The question is whether we can reverse or intervene with these neuropathic problems. And we don’t know that because they’re often silent. And so, we don’t know whether they’ve crossed a point of no return, and we can actually reverse them, or we’re just treating the symptoms. So, at least we can treat symptoms. And in the future, we hope to be able to more precisely predict who will get them, identify them early and try to reverse or prevent them. We’re not there yet, though. Urologic problems, including urinary and sexual dysfunctions, are common in men and women with diabetes, both type 1 and type 2. Very severe late-stage problems are rare, but we need to ask patients whether they’re having symptoms and if they are, then we need to do more formal work-up to make sure their bladder is emptying completely and importantly, that we’re treating their symptoms.