Page 158 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

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applied. A worldwide registry, with extensive and validated use of PROMS before and after surgery, including all patient characteristics, would possibly identify pre-operative risk factors for complications and might improve the patient selection for this treatment and other invasive treatments within functional urology. Within the near future, it might be optimistic to realize such registry. Therefore, until such implementation, all centers need to register PROMS and outcomes diligently to at least improve the quality of the available data.
EPILOGUE AND SUGGESTIONS FOR FUTURE RESEARCH
This thesis investigated the brain areas involved in central control of the LUT and thereby increased the knowledge on (patho-)physiology of bladder dysfunctions. Furthermore, with using 7T-fMRI we identified a possible objective outcome measurement within the field of functional urology. We have made progress in profound knowledge on both objective (urodynamic studies) and subjective (OAB-q SF questionnaire) outcomes measurements, and investigated the prognostic factors for complications on invasive surgery within functional urology. Functional urology is a challenging sub-specialty in which the use of a prudent combination of objective and subjective outcome measures is necessary to provide optimal care. There is room for improvement of these outcome measures, the possibilities of which we explored. However, still many questions remain. Therefore, suggestions for future research are divergent, ranging from basic science to postulate the pathophysiology of functional bladder disorders to clinical research yield- ing more data on outcome measures.
- In dynamic brain imaging, more individually assessable data needs to be generated on both healthy subjects and bladder dysfunction patients, with protocolled scan, task and analytic paradigms. This approach will increase the knowledge on the pathophysiology, and possibly reveal therapeutic targets.
- The search for alternative techniques to study activity patterns and therapeutic targets, that are easier accessible and less prone to artefacts needs to continue. Candidate techniques are near-infrared spectroscopy and transcranial magnetic stimulation.48
- In clinical practice, the use of standardized PROMS-sets needs to be encouraged, which will greatly contribute to developing of a good prediction model, thereby enlarging the chance of successful treatment in patients with functional bladder disorders.
- A registry needs to be developed for patients needing invasive treatments for func- tional bladder problems. This registry will, apart from the stimulation for the use of