From pharmacological management to regenerative medicine: a bibliometric analysis of global trends and evolutionary patterns in diabetic bladder dysfunction (2000–2024)

Introduction

The sustained rapid rise in global diabetes prevalence constitutes one of the most critical public health challenges in the 21st century, with its chronic complications imposing a substantial burden on healthcare systems. Among these complications, diabetic bladder dysfunction (DBD), also known as diabetic cystopathy or diabetic bladder, represents an extremely prevalent chronic condition that significantly compromises patients’ quality of life. Research indicates that more than 50% of diabetes patients are affected by DBD (1-4). DBD primarily manifests as a complex array of variable lower urinary tract symptoms (LUTS) during storage and voiding phases, including urinary frequency, urgency, incontinence, dysuria, and elevated post-void residual (PVR), significantly compromising patients’ physical and psychological well-being (5,6).

Notably, the clinical manifestations of DBD are not static, and its pathophysiological process exhibits a dynamic phasic progression. According to the classical ‘temporal theory’, early-stage diabetes often manifests as compensatory bladder hypertrophy and detrusor overactivity, presenting with storage-phase symptoms such as urinary frequency and urgency; with prolonged disease duration, the condition progresses to the decompensation stage, characterized by decreased bladder sensation, significantly increased capacity, weakened detrusor contractility progressing to underactivity, ultimately leading to urinary retention and increased PVR urine (2,7,8).

This complex evolution reflects progressive damage at multiple levels including bladder smooth muscle, innervation, urothelium, and microvasculature, with core mechanisms involving multiple pathological processes such as oxidative stress, accumulation of advanced glycation end-products (AGEs), inflammation activation, and microcirculatory dysfunction triggered by chronic hyperglycemia (9-11). However, facing such a complex pathological basis, traditional clinical treatment strategies primarily focus on controlling downstream symptoms, such as the use of antimuscarinic agents to treat overactive bladder (OAB) (12). These symptomatic therapies not only yield minimal therapeutic benefits in advanced-stage disease characterized by detrusor underactivity, but may also exacerbate residual urine volume and associated dysuria through suppression of bladder contraction, underscoring the current clinical management dilemma (13).

Given these limitations, the research community has gradually shifted focus toward seeking breakthroughs through investigations of upstream mechanisms. In recent years, research focus has deepened to explore the core roles of molecular mechanisms such as oxidative stress and NLRP3 inflammasome activation in the pathogenesis and progression of DBD (9,14,15). Building on these mechanistic insights, intervention strategies have moved beyond traditional receptor antagonists to explore approaches such as scavenging free radicals, inhibiting AGEs, or blocking inflammatory signaling pathways to delay or even reverse bladder dysfunction (10,16,17). Against this backdrop, physical regenerative medicine approaches represented by low-intensity extracorporeal shock wave therapy (Li-ESWT) demonstrate substantial potential. Research indicates that Li-ESWT improves bladder emptying function in diabetic animal models, potentially through mechanisms involving promotion of local angiogenesis, restoration of nerve innervation, alleviation of inflammation, and reduction of fibrosis (18-20), marking the advancement of DBD treatment into a new phase transitioning from ‘pharmacological control’ to ‘tissue repair’ (13). Despite the increasing volume of research literature on the pathogenesis and emerging therapies for DBD, the knowledge base in this field remains fragmented and lacks systematic synthesis. Most reviews focus on in-depth explanations of specific mechanisms or particular therapies, failing to provide a holistic mapping of the macro-structure, historical evolutionary trajectory, and shifts in research hotspots across the entire research domain. Furthermore, existing bibliometric studies predominantly concentrate on broader complication domains such as diabetic nephropathy, with no bibliometric analysis having mapped the transformative landscape of global research trends in DBD.

To bridge this critical gap, this study presents a systematic bibliometric analysis of global DBD research spanning 2000 to 2024. Employing bibliometric and knowledge mapping visualization methods, this work systematically maps the field’s 25-year developmental trajectory, national/institutional collaboration networks, core author groups, and the evolution of research fronts toward regenerative repair strategies, thereby providing a roadmap for future DBD translational research and clinical innovation.

Study objectives

The objectives of this study were to: (I) characterize the temporal evolution of global DBD research output from 2000 to 2024; (II) identify the leading contributing countries, institutions, journals, and authors; (III) map key research themes through keyword co-occurrence and citation analysis; and (IV) delineate emerging frontiers, particularly in regenerative medicine and shock wave therapy. We present this article in accordance with the BIBLIO reporting checklist (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0296/rc) (21).

Methods

Data sources and search strategy

Literature data were retrieved from the Web of Science Core Collection (WoSCC), including the SCI-EXPANDED, SSCI, and ESCI indexes. To comprehensively analyze the evolution of diabetic bladder, the time span was set from January 1, 2000, to August 8, 2024. The search was conducted on August 10, 2024, to avoid bias introduced by database updates. The retrieval strategy utilized the ‘Topic’ field, encompassing titles, abstracts, and keywords. The search query incorporated DBD-related terms such as ‘diabetic bladder’ and ‘diabetic bladder dysfunction’ (detailed search strings are available in Appendix 1). To ensure text mining consistency, the search was limited to English-language publications.

Inclusion criteria and data screening

Initially, 2,278 records were identified. Document types were strictly limited to ‘Article’ to represent original research contributions; Meeting Abstracts, Letters, Early Access publications, Retractions, Retracted Publications, and Reviews were excluded. This step yielded 1,581 candidate articles (Figure 1). Given that the combination of keywords ‘diabetes’ and ‘bladder’ is relatively broad, it may include false-positive results (e.g., studies solely on bladder cancer in diabetic patients). To ensure high data accuracy, we implemented a rigorous two-stage manual screening process. In the first stage, two independent researchers reviewed the titles and abstracts of all candidate articles to exclude studies unrelated to DBD pathology, diagnosis, or treatment. In the second stage, the full texts of the remaining articles were retrieved and assessed to confirm final eligibility. Discrepancies were resolved through consultation with a third researcher. Ultimately, 264 high-quality core articles met the inclusion criteria (The complete list of included articles is provided in https://cdn.amegroups.cn/static/public/tau-2026-0296-1.xlsx). The “Full Record and Cited References” of these articles were exported in Plain Text File format. As this study constitutes a bibliometric analysis of publicly available literature, ethics committee approval was not required.

Figure 1 Flowchart of the literature screening and selection process. A total of 264 core articles on diabetic bladder dysfunction were finally included for the bibliometric analysis after a rigorous screening to remove irrelevant or non-functional studies.

The inclusion criteria encompassed both clinical studies (e.g., randomised controlled trials, observational studies, cross-sectional studies) and preclinical studies (e.g., animal model experiments, in vitro studies) evaluating DBD or its pathophysiological mechanisms. No restriction was placed on geographic origin, patient/subject characteristics, or therapeutic modality, provided that DBD was a primary or secondary outcome of the study.

Cross-database validation

To meet the requirement for multi-database validation and ensure the representativeness of the data source, a cross-database verification was conducted using Scopus. Specifically, we queried the digital object identifiers (DOIs) of the final 264 core original articles included from the WoSCC within the Scopus database. The results demonstrated a highly significant overlap, with 259 out of the 264 articles (98.1%) being co-indexed in Scopus. This exceptionally high concordance confirms that the WoSCC database provides robust and comprehensive coverage of the high-impact literature in this field, thereby rigorously justifying its use as the primary database for our bibliometric network visualization without significant selection bias.

Bibliometric analysis and visualization

The conceptual, social, and intellectual structures of this field were analyzed and visualized using the following tools: VOSviewer (v1.6.19) for constructing and visualizing co-occurrence networks of keywords and journals; CiteSpace (v6.2.R4) was employed to analyze citation bursts, dual-map overlays, and keyword timeline views. The time slicing was set to 1-year intervals (2000–2024), with node selection criteria set to g-index (k=25), and the “Pathfinder” algorithm was applied to optimize network clarity. SCImago Graphica (v1.0.35) was used to map the geographic distribution of countries/regions and the intensity of international collaborations; Origin 2022 was employed to visualize annual publication trends.

Keyword co-occurrence analysis was performed on author keywords (DE field) and KeyWords Plus (ID field) as exported from the WoS Core Collection. For keyword co-citation and cluster analysis in CiteSpace, terms were extracted from the title, abstract, and keyword fields of all 264 included articles, with a minimum term frequency threshold of 2 and a minimum co-occurrence count of 1. Co-citation analysis was performed on the reference lists of the 264 included original articles using CiteSpace. This analysis identifies the most co-cited external references (publications cited together most frequently by the included articles), which may include original articles, review articles, and other document types. These co-cited references are distinct from the 264 original articles in our primary dataset.

Results

Global publication trends and geographic distribution overview

Figure 2 illustrates the global output trends and spatial patterns in diabetic bladder research. Bibliometric analysis revealed a fluctuating upward trajectory in annual publication volume between 2000 and 2024, peaking in 2020 (21 publications) (Figure 2A). Regarding spatial distribution and international collaborations (Figure 2B,2C), U.S. and China anchor the core positions of the global research network. Among them, U.S. not only leads in publication volume but also occupies the central hub position in the international collaboration network. Its primary collaborative links extend to China, Japan and the United Kingdom, demonstrating that these countries constitute the main scientific force driving advancement in this field.

Figure 2 Global publication trends and international cooperation networks. (A) The annual number of publications in diabetic bladder dysfunction research from 2000 to 2024, showing a fluctuating upward trajectory. (B) Geographical distribution and collaboration network of countries/regions. The node size corresponds to the publication volume. (C) A chord diagram visualizing the international collaboration network, where the thickness of the connecting lines indicates the total link strength between countries, highlighting the USA and China as core hubs.

Spatiotemporal dynamics of regional contributions

Table 1 depicts the temporal evolution of citation bursts among the top 13 countries from 2000 to 2024, revealing dynamic spatiotemporal shifts in global research focus. Analysis indicates that United States (burst strength 3.39) and Canada (burst strength 1.21) exhibited the strongest citation bursts during the initial phase (2003–2005), establishing their pioneering dominance in this field. Subsequently, research activity shifted to Japan (2007–2009) and the United Kingdom (2009–2011). Notably, the global research landscape has shown significant diversification in recent years, with Greece (strength 1.53), Germany (strength 1.44), and Saudi Arabia (strength 1.06) exhibiting prominent citation bursts from 2019 to 2024, marking the emergence of new research centers.

Analysis of core institutional collaboration networks and leading scholars

Network visualization (Figure 3) identified the University of Pittsburgh and the University System of Ohio as key nodes in the institutional collaboration network. The burst analysis across the time dimension (Table 1) demonstrated that Ohio State University held dominance during the early period (2002, strength 3.04), while recent research hotspots (2019–2024) have notably shifted toward Duke University, as well as China’s Guangzhou University of Chinese Medicine and Chengdu University of Traditional Chinese Medicine. At the scholar level (Table 2), Bauer JA and Chancellor MB established foundational influence during the initial research phase, whereas Jin Huixia, Purves J Todd, and Hughes Francis M represent the emerging contemporary leading forces from 2022 to 2024.

Figure 3 The collaboration network of institutions. The network generated by CiteSpace visualizes the cooperative relationships among major research institutions in diabetic bladder dysfunction research. The links indicate collaborative ties, with institutions such as the University of Pittsburgh and the University System of Ohio serving as key nodes in the network. Institution names are displayed as indexed in Web of Science.

Disciplinary knowledge flow and core journal dynamics

The dual-map overlay analysis (Figure 4) visualized interdisciplinary citation trajectories, revealing that primary knowledge flows predominantly originated from the “Medical/Clinical” and “Molecular/Biological/Immunological” journal clusters on the left and converged toward the “Molecular/Biological/Genetics” and “Health/Nursing/Medical” clusters on the right. This highlights a trend transitioning from clinical observations and fundamental medicine to specific molecular mechanisms and nursing strategies. Journal burst analysis (Table 2) further identified the evolution of high-impact journals: Diabetologia established its foundational role during the early period (2002–2010, strength 9.76); In contrast, recent bursts (2019-2024) are concentrated in International Journal of Molecular Sciences, Frontiers in Pharmacology, and Research and Reports in Urology, reflecting a current shift in scholarly focus toward molecular pharmacology and specialized urological reporting.

Figure 4 A dual-map overlay of journals illustrating interdisciplinary knowledge flow. The citing journals are positioned on the left (representing research fronts), and the cited journals are on the right (representing the knowledge base). The colored paths indicate the primary citation trajectories, highlighting a translational trend from clinical observation and basic medicine to specific molecular mechanisms and nursing strategies.

Domain knowledge cornerstones and landmark publications

Table 3 presents the top 20 references with the strongest citation bursts, outlining the knowledge base in this field. The review article by Daneshgari F et al. (2009) exhibited the highest burst strength (9.21, duration 2012–2014), establishing it as a theoretical cornerstone in the field. Furthermore, sustained citation bursts during the recent period (2019–2024) have primarily centered on research by Wittig L (2019), Ellenbroek JH (2018), and Inouye BM (2018), indicating that current academic frontiers focus on exploring novel pathophysiological mechanisms and validating clinical relevance.

Table 3 lists the top 20 most-cited references identified through co-citation analysis in CiteSpace, operating on the reference lists of the 264 included original articles. These co-cited references are distinct from the 264 primary articles and represent the foundational literature of the field. The complete list of co-cited references is provided in https://cdn.amegroups.cn/static/public/tau-2026-0296-1.xlsx.

Research hotspots and thematic evolution trajectory

Figure 5 clearly delineates the paradigm shift in research themes through a timeline view of keyword clustering. This field has undergone three distinct phases: early-stage research (2000–2010) was predominantly driven by fundamental physiology and pharmacological targets, with Cluster #12 (‘bladder detrusor muscle’) and Cluster #3 (‘diabetic bladder’) as core themes, featuring high-frequency terms including ‘muscarinic receptors’ and ‘smooth muscle’. The subsequent transitional phase (2010–2018) marked a deeper exploration into underlying pathological mechanisms, with Cluster #1 (‘hypoxia’) becoming the focal point, accompanied by the widespread emergence of keywords such as ‘oxidative stress’ and ‘inflammation’. Particularly noteworthy is that the post-2019 period witnessed the emergence of Cluster #10 (‘defocused low-energy shock wave’) as a burgeoning hotspot, indicating a paradigm shift in therapeutic strategies—transitioning from traditional symptom management toward regenerative medicine approaches targeting tissue regeneration and microcirculation improvement.

Figure 5 Timeline view of keyword clusters reflecting the evolution of research hotspots. The clusters illustrate a clear paradigm shift across three stages: early physiological and symptomatic characterization (e.g., muscarinic receptors), intermediate mechanistic exploration (e.g., hypoxia, oxidative stress), and recent regenerative interventions (e.g., defocused low-energy shock wave).

Notably, Cluster #10 (LLR label: defocused low-energy shock wave) has quantitative characteristics indicative of an emerging rather than established research domain: cluster size = 20, silhouette value = 0.85, mean publication year = 2020, with primary LLR-matched terms showing low absolute frequencies (defocused low-energy shock wave: count = 2; interstitial cells: count = 2; guinea pig bladder: count = 2). These metrics confirm that Cluster #10 represents an early-stage emerging frontier with limited but growing literature. A complete quantitative summary of all 13 clusters is provided in Table S1.

Discussion

Global research landscape: transition from U.S. dominance to multipolar collaboration

It is important to note at the outset that the bibliometric analysis in this study encompasses both clinical and preclinical literature. Readers should therefore interpret all identified research trends as reflecting the combined clinical-preclinical literature landscape rather than established clinical evidence alone. This distinction is particularly relevant for the interpretation of emerging therapeutic clusters (see Section Therapeutic evolution: regenerative medicine and shock wave therapy).

Our bibliometric analysis reveals a fluctuating upward trend in publication volume in this field, peaking around 2020, which coincides with the continuous rise in global diabetes mellitus prevalence and growing attention to its complications (6). The overwhelming dominance in early research originated from U.S., with foundational work primarily based on systematic animal models established by pioneers such as Daneshgari F, providing a robust basis for understanding DBD pathophysiology (7,22). However, a pronounced geographical shift in research hubs has occurred over the past decade. A surge in citations from China and emerging European centers, such as Greece and Germany, signifies a diversification of the global research landscape. This evolution is not coincidental; it is driven not only by sustained investments in research funding but also by the mounting challenges posed by an increasingly large aging diabetic population in these regions. The resulting epidemiological trend has imposed a substantial clinical burden, particularly regarding interventions for late-onset LUTS and refractory urinary retention. Consequently, this has propelled a shift in the research focus of this field, transitioning from the elucidation of basic physiological mechanisms in early animal models [such as altered muscarinic receptor function and abnormal smooth muscle contractility (23,24)] to translational medicine focused on disease treatment development. The extensive international collaboration network demonstrates that DBD research has evolved from isolated physiological studies to large-scale, multicenter collaborative efforts, despite the need to strengthen connections between U.S.-dominated basic science and globally conducted clinical trials.

Pathophysiological paradigm: tracing from symptom downstream to mechanism upstream

Early research keywords were heavily concentrated on ‘muscarinic receptors’ and ‘smooth muscle contractility’, directly reflecting the era’s symptom management strategies centered on antimuscarinic agents (12). However, this strategy faces clinical limitations: when DBD progresses to the decompensation stage (manifested as detrusor underactivity or urinary retention), conventional antimuscarinic agents are not only ineffective but may further increase PVR, thereby exacerbating dysuria (25,26). This contradiction has driven deeper understanding, prompting the academic community to shift from focusing solely on downstream receptor antagonism to seeking breakthroughs in upstream pathogenesis mechanisms.

The ‘temporal theory’ proposed by scholars marked a pivotal turning point, which systematically delineates the dynamic progression of DBD from early compensatory hypertrophy and hyperactivity to late-stage decompensation and hypoactivity (2,7). Correspondingly, the mid-term keyword clusters identified in this analysis—‘oxidative stress’, ‘hypoxia’, ‘apoptosis’, ‘autonomic neuropathy’—precisely delineate the upstream mechanisms driving this process. Numerous studies have substantiated that excessive reactive oxygen species (ROS) production, mitochondrial dysfunction, and resultant oxidative damage induced by chronic hyperglycemia constitute the core drivers leading to apoptosis and functional impairment in bladder smooth muscle cells, neurons, and urothelial cells (4,11,27,28). Notably, these pathological alterations in the bladder are not isolated events; they essentially represent specific manifestations of systemic diabetic complications in the bladder organ. Systemic microangiopathy and metabolic dysregulation may induce chronic ischemic hypoxia in the bladder wall (29,30), while diabetic autonomic neuropathy impairs neural pathways innervating bladder sensory and motor functions (31,32). Consequently, the contemporary pathophysiological paradigm conceptualizes DBD as an integrated organ dysfunction initiated by metabolic dysregulation, involving multifaceted damage to neural, vascular, muscular, and urothelial components.

Therapeutic evolution: regenerative medicine and shock wave therapy

It is important to note that the bibliometric analysis underlying these findings encompasses both clinical and preclinical literature. Within Cluster #10, the identified studies on shock wave therapy and regenerative medicine predominantly comprise preclinical animal studies and early-phase clinical investigations. Readers should therefore interpret the identified research trends as reflecting the combined clinical-preclinical literature landscape rather than established clinical evidence alone. The transition from preclinical proof-of-concept to clinical validation remains an important gap that the field must address.

Among the most illuminating findings of this study is the recent emergence of a distinct cluster centered on ‘defocused low-energy shock wave’, co-occurring with high-frequency terms such as ‘nerve growth factor’ (NGF) and ‘regeneration’. This signifies the advent of a novel therapeutic paradigm: a transition from pharmacological containment to regenerative restoration.

Traditional pharmacological treatments focus on blocking or mimicking specific neurotransmitter receptors to modulate symptoms, whereas physical-biomodulatory therapies such as Li-ESWT and stem cell therapy aim to target and repair the underlying pathological damage in DBD, thereby promoting tissue self-repair and functional reconstruction (18,19). Research demonstrates that Li-ESWT, through its mechanotransduction effect, can upregulate expression of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOS), promoting angiogenesis and thereby improving bladder ischemia (18,19); meanwhile it enhances NGF expression, providing trophic support for regenerating impaired bladder sensation and autonomic nerves (20,33,34). In addition, Li-ESWT has been shown to reduce apoptosis in bladder smooth muscle cells and reverse fibrotic alterations caused by diabetes (18,30). These effects enable Li-ESWT to effectively improve detrusor underactivity and reduce PRV in animal models, thereby challenging the conventional perspective that ‘the DBD decompensation stage is irreversible’ (18,19). Stem cell-based regenerative therapies such as adipose-derived stem cell or amniotic membrane-derived stem cell transplantation also promote angiogenesis and neural repair through analogous paracrine mechanisms (releasing growth factors like VEGF and NGF), demonstrating potential for restoring bladder function in animal studies (34-36). These emerging therapies not only challenge the traditional clinical perception of the bladder’s decompensated stage as irreversible, but also represent a shift in DBD treatment from symptom management to functional restoration.

Strengths and limitations

Through rigorous bibliometrics methodology, this study provides unique perspectives and evidence for understanding the aforementioned evolution in the DBD field. Its core strength lies in implementing a strict two-stage manual full-text screening process, distinguishing it from generalized literature analyses based on large-scale automated retrieval. This approach enabled precise identification of 264 core original research articles from 1,581 candidate publications. This relatively small sample size is not a flaw; rather, it ensures the constructed knowledge network remains highly focused on the core theme of specific bladder dysfunction caused by diabetes itself. This approach maximally eliminates ‘noise literature’ from unrelated topics such as comorbid bladder cancer or simple urinary tract infections, resulting in trend analysis findings of high purity and precision. However, this study does have certain limitations. First, this study’s data sources are confined to the authoritative WoSCC database. This limitation may result in the omission of relevant studies indexed in Scopus, Embase, or non-English journals (such as those published in localized native languages). Second, citation burst analysis in bibliometrics inherently suffers from a lag time effect, where newly emerging high-potential research may require a longer period to manifest its influence through citation accumulation. Third, the relatively small corpus of 264 articles, while ensuring thematic precision, may limit the statistical reliability of network-based metrics compared to larger automated corpora. Fourth, while we have clearly characterized the trending shift from traditional pharmacological management toward regenerative medicine strategies such as Li-ESWT, current evidence for these emerging interventions is primarily derived from basic animal models or preliminary clinical observations. Their long-term safety and definitive clinical translational efficacy remain to be validated by future large-scale, multicenter randomized controlled trials (RCTs).

In summary, this study systematically depicts a comprehensive evolution map of the DBD field, progressing from basic to clinical research, from symptoms to mechanisms, and from pharmacological treatments to regenerative repair. Future research should continue to deepen the understanding of the complex mechanisms of DBD, particularly focusing on molecular pathways in type 2 diabetic models (13,37) and actively facilitating the translation of regenerative repair strategies such as Li-ESWT and stem cell therapy from laboratory research to clinical applications. Concurrently, in clinical practice, enhanced screening and early identification of bladder dysfunction should be implemented for diabetic patients, particularly elderly individuals and those with prolonged disease duration (38,39), and individualized management strategies should be developed based on the disease phase (compensation stage or decompensation stage). Through interdisciplinary efforts, DBD is expected to transition from a ‘difficult-to-treat’ complication into a preventable, manageable, and even partially reversible disease state.

Future research directions

Based on the bibliometric evidence synthesized in this study, the following research priorities are recommended: (I) prospective RCTs on regenerative therapies (Li-ESWT, stem cell therapy) for DBD, grounded in Cluster #10 (mean year 2020; silhouette = 0.85), which documents their recent emergence but reflects predominantly preclinical evidence requiring clinical validation. (II) Mechanistic investigation of neuroinflammatory and oxidative stress pathways identified in Cluster #1 (LLR: hypoxia; high-frequency terms: oxidative stress, NLRP3 inflammasome), the axis offering the most targetable intervention points. (III) US-China multicenter RCTs, leveraging contemporaneous citation burst peaks of Duke University (strength 2.18, 2022–2024), Guangzhou University of Chinese Medicine (strength 2.43, 2019–2022), and Chengdu University of Traditional Chinese Medicine (strength 2.02, 2020–2024). (IV) longitudinal studies of the compensated-to-decompensated DBD transition, informed by Cluster #8 (mean year 2019; silhouette = 1.00), to identify the critical intervention time-window.

Conclusions

In summary, this bibliometric analysis elucidates the evolution of DBD research from 2000 to 2024. The field has undergone a paradigm shift: from primarily focusing on symptomatic control through pharmacological receptor antagonism to gaining deeper insights into oxidative stress and hypoxia mechanisms. The key insight is that the recent emergence of Li-ESWT as a prominent research focus represents a breakthrough in regenerative medicine approaches for DBD management, signifying a paradigm shift from symptomatic treatment toward curative interventions designed to restore microcirculation and reverse tissue remodeling. While U.S. has established foundational physiological frameworks, the increasingly diversified global research landscape holds promise for accelerating clinical translation. Future research should prioritize large-scale, multicenter clinical trials to validate the efficacy of these regenerative therapies, ultimately contributing to improved treatment of diabetic urological complications.

Acknowledgments

During the preparation of this manuscript, the authors used Gemini (Google) strictly for language polishing and improving the readability of the English text. After using this tool, the authors rigorously reviewed, edited, and validated the content as needed, and take full responsibility for the final content of the publication.

Footnote

Reporting Checklist: The authors have completed the BIBLIO reporting checklist. Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0296/rc

Peer Review File: Available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0296/prf

Funding: This work was supported by Yunnan International Joint R&D Center of Key Technologies in Urological Diagnosis and Treatment (Grant Number: 202403AP140016), the Yunnan Provincial Expert Workstation of Zhang Yaoguang (Grant Number: 202405AF140058), and the Medical and Health Talents of the “Xingdian Talent Support Program” of Yunnan Province (Grant Number: XDYC-YLWS-2024-0024).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tau.amegroups.com/article/view/10.21037/tau-2026-0296/coif). K.F. reports that the present manuscript received financial support from the Yunnan International Joint R&D Center of Key Technologies in Urological Diagnosis and Treatment (Grant Number: 202403AP140016), the Yunnan Provincial Expert Workstation of Zhang Yaoguang (Grant Number: 202405AF140058), and the Medical and Health Talents of the “Xingdian Talent Support Program” of Yunnan Province (Grant Number: XDYC-YLWS-2024-0024). The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. As this study is a bibliometric analysis based on publicly available literature and does not involve direct human or animal experiments, it is exempt from ethical committee approval and informed consent requirements.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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