Page 156 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

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Chapter 8
of therapies. Furthermore, it might save time and healthcare costs and could reduce symptom bother and needless side effects of insufficient therapies.27 To realize such a personalized management tool, the amount of data on patient characteristics, diseases, outcomes, patient reported outcome measurements (PROMS) and risk for complications needs to increase and the quality of the data needs to improve. In the second part of this thesis we aimed to evaluate and improve traditional outcomes and PROMS.
Improvement of the use of objective outcomes in functional urology
An objective outcome in the field functional urology is a urodynamic study. It measures several parameters in context of bladder function during both the filling and voiding phase, like bladder capacity, compliance and contractility.28 Previous studies have inves- tigated whether urodynamic parameters in patients with overactive bladder are predic- tive for the chance of success upon sacral neuromodulation (SNM). A significant relation between urodynamic parameters and outcomes of the test phase for SNM has not been demonstrated.29,30 Nevertheless, significant changes on urodynamic parameters were seen during SNM therapy > 6 months.31,32 The objective of the study in chapter 5 was to demonstrate whether this effect on urodynamic parameters was visible after acute SNM. We demonstrated that there was no immediate effect of SNM on standard urody- namic parameters. In contrast, Dombek et al. recently demonstrated an acute effect of transcutaneous electrical nerve stimulation on urodynamic parameters in children with a neurogenic bladder.33 The influence of the differences in age, bladder disorders, type of neuromodulation and underlying neurological disorder between Dombek et al. and our study chapter 5, is unclear. Apart from predicting success rates of SNM using uro- dynamic parameters, another argument to study acute effects of SNM is to explore the feasibility of a closed-loop feedback system, in which SNM is activated when the bladder pressure increases in the context of detrusor overactivity.34,35 The effect of intermittent SNM seems comparable to that of continuous SNM, which might imply the appropriate- ness of such closed-loop feedback system.36
Predicting outcomes of therapies in patients with overactive bladder has not been very successful yet, causing that often multiple therapies are explored to find the most efficient one. Chapter 5 is in accordance with other literature which mentions that objec- tive parameters do not seem appropriate as prognostic measurements for the success of SNM treatment in overactive bladder.29,30,37 The question raises whether dynamic brain imaging plays a future role as objective parameter in the prediction of responses to therapy. In this context, acute and chronic effects of SNM on activation patterns in brain areas have been demonstrated in patients.38 For near future predictive models, the use of PROMS might be suitable, since the outcomes of objective and subjective measure- ments still seem to be very divergent in patients. The consistent use of validated PROMS