Page 19 - Bladder Dysfunction in the Context of the Bladder-Brain Connection - Ilse Groenendijk.pdf

Introduction 17
non-responders. Patients who have an improvement of at least >50% of symptoms in the test-phase are considered as responders and are candidates for the definitive sacral neuromodulation system. The test phase is currently the only way to select patients for this treatment option; predictive patient characteristics or predictive measurements like urodynamic parameters have not yet been defined.46, 47 Sacral neuromodulation for neuro-urological patients is thus far not reimbursed, as there is a lack of evidence and it is unclear which patients are most suitable.48, 49
Both in non-neuro-urological patients as in neuro-urological patients with UAB or an inability to void, indwelling catheters (suprapubic or urethral) or clean intermittent cath- eterization can give rise to problems such as urinary tract infections, pain and bleeding. The construction of a continent catheterizable urostoma can be considered. As this is invasive surgery for a non-lethal disease, the risk and benefits have to be considered. A fair comparison is challenging, however, as the literature on the risks of reoperation and complications is scarce.50
1.7 AIMS OF THIS THESIS
In general, the aim of this thesis is to investigate potential diagnostic tools in the field of functional urology. This is further specified into two sub aims:
1) To define the brain areas involved in LUT control in healthy individuals and to in-
vestigate the clinical applicability of dynamic brain imaging as a diagnostic tool of
functional bladder disorders in individuals.
2) To evaluate and improve traditional and patient reported outcome measurements in
the field of functional urology.
1.8 OUTLINE OF THIS THESIS
Part I. The use of dynamic brain imaging as potential diagnostic tool within functional urology.
The first part of this thesis is dedicated to the innervation of the LUT and the applicabil- ity of dynamic brain imaging as a diagnostic tool in individuals. Firstly, to define the brain areas involved in motor control of the LUT, all evidence on this topic is summarized with a thorough systematic review, including a coordinate-based meta-analysis of all included data (chapter 2). In chapter 3 the central motoric innervation of the LUT is investigated. Chapter 4 focusses on the sensory innervation of the male genitals. In both chapters 3 and 4, the involved brain areas in the whole brain are identified with the use of 7 Tesla fMRI on both group level and individual level.
1