Page 169 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

In functional urology, results of objective outcomes can diverge much from the results of subjective outcomes in the same patient. Functional disorders can cause a wide range of symptoms, of which the influence on quality of life can differ per person. Therefore, apart from objective measurements like bladder diaries and urodynamic studies, patient reported outcome measurements (PROMS) are of utmost importance. A worldwide often used questionnaire for patients with overactive bladder symptoms is the OAB-q SF which is included in the value-base healthcare consortium ICHOM dataset on OAB. Chapter 6 reports how this questionnaire was translated and validated in the Dutch language. It appeared to be a valid PROM which now be used in clinical practice in the Netherlands.
The protocolled use of PROMS in clinical practice is encouraged, as it may lead to better outcomes of personalized therapies. Prognostic factors for outcomes of both conservative and invasive therapies have not yet been identified. The outcomes of a continent catheterizable urinary channel in adults were evaluated in the study presented in chapter 7. This invasive therapy for patients with functional bladder problems is not often performed, and consequently little is known on the risk factors for complications. All patients who received such channel during the past 20 years in either the Erasmus University Medical Center or the University Medical Center Groningen were retrospec- tively included in this study. The underlying cause for bladder disorders was neurogenic in 26 out of the 41 patients included in this study. The probability of a surgical revision of the channel due to complications like stenosis or leakage was greater than 40%. Apart from a higher age during surgery, no significant risk factors were identified, which is pre- sumably related to the small patient sample. A future perspective is the development of a worldwide registry for patients who undergo invasive surgery for functional bladder disorders, including both objective and subjective outcome measurements. This will possibly identify risk factors for invasive surgery. As the development of such registers will take time, until implementation, centers need to be encourage to use validated and standardized outcomes.
In chapter 8, the general discussion of this thesis, the possible applicability of dy- namic brain imaging in functional urology, as well as the applicability of dynamic brain imaging in individuals is discussed. Some potential issues are that the technique is time consuming and prone to artefacts, and that 7T is still limitedly available and relatively expensive. Most of these issues are resolvable, however, when technique evolves in due time. The general discussion furthermore describes that clinical research in functional urology is challenging due to the lack of reproducible objective parameters. The main goal is a better prediction on outcome measures and risk factors in individual patients. This is a prerequisite for personalized medicine in functional urology. Relevant research ranging from basic science to PROMS in clinical practice must be encouraged in order to improve health care in the field of functional urology.
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Summary and Nederlandse samenvatting 167