Page 153 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf
P. 153

                 In the field of functional urology, the availability of outcome parameters is limited. At present, the main outcomes are related to the subjective symptom perception of the pa- tient. Due to the lack of outcome parameters, progress in scientific and clinical research in the field of functional urology might be obstructed. In this thesis, we attempted to expand the knowledge on (patho)physiology, identifying objective outcome measure- ments, improving subjective outcome measurements in the form of patient reported outcome measurements (PROMS), and contribute to the development of prediction models towards personalized care in functional urology.
DYNAMIC BRAIN IMAGING: A FUTURE DIAGNOSTIC TOOL IN FUNCTIONAL UROLOGY?
In the first part of this thesis we focused on the innervation of the lower urinary tract (LUT) and investigated the possible use of dynamic brain imaging as objective outcome measurement in clinical practice.
1. Do we know which brain areas are of interest when investigating the LUT?
The evolution of dynamic brain imaging generated an increase in knowledge on the innervation of the LUT.1-5 Still, there is no consensus on which brain areas are involved in central LUT control.6 Several properties of the acquisition and processing of dynamic brain imaging, make it hard to summarize the available data. Examples of these proper- ties are the heterogeneous characters of the tasks performed in the MRI scanner (for instance different ways of bladder filling), the heterogeneous scan paradigms (for instance length and repetition of tasks), mixed genders, mixed patient populations as well as differences in used techniques (PET/1.5T fMRI/3T fMRI). A coordinate-based meta- analysis can be used to create a comprehensive overview of the relevant brain areas. A widely accepted method for coordinate-based meta-analysis is the activation likelihood estimation (ALE) which uses the inserted coordinates as a spatial probability distribu- tion. In chapter 2, an ALE analysis using all published data on this topic indicated which brain areas are involved in the motor control of the LUT, divided into pelvic floor muscle contraction and micturition. The shortage of available data necessitated us to perform the ALE analysis with a lenient threshold; the results should thus be interpreted with caution. The results of this chapter are, to the best of our knowledge, the first results on motor innervation of the LUT investigated in more than 100 patients.
The brain areas that showed to be involved are in accordance with the findings of other relevant systematic reviews (without meta-analysis), although most literature focused on bladder control and not on pelvic floor muscle control.6-9 We have demonstrated that two different motor tasks of the LUT, are innervated by distinct brain areas.
8
General discussion and future perspectives
151
 

























































































   151   152   153   154   155