We appreciate the comments of Drs Rabin and Badlani concerning our article.1 As they correctly noted, many of the patients in our study had previously suffered from cerebrovascular accidents. This is a reflection of the type of illnesses seen in the elderly nursing home population. One of the points of our article was that, due to the special nature of this group of patients, the bladder function of the diabetic patient may be different from what might be expected. The elderly institutionalized patient may have a neurologic disease that impacts on the urinary system. Indeed, involuntary contractions of the bladder may be common in elderly patients in general. These factors help in explaining the unexpected finding of detrusor instability in the institutionalized elderly diabetic patient with urinary dysfunction. It certainly indicates that the diagnostic and therapeutic plan for these patients may be different from that for the
Starer P, Libow LS. Importance of Complete Cytometric Evaluation of Vesical Dysfunction in Elderly Diabetic Patients-Reply. Arch Intern Med. 1991;151(1):202–203. doi:10.1001/archinte.1991.00400010181038
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