Measurement of Neuroexcitation during Bladder Filling: A Novel Metric for Overactive Bladder Phenotyping

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Project Summary: Overactive Bladder (OAB), defined mainly by the symptom of urinary urgency, is a multifactorial condition, affecting more than 25% of the population. Because urgency is the brain's interpretation of multifactorial events, it is important to understand areas of brain activation that occur during bladder filling. Recently, there has been a growing body of research using functional MRI (fMRI) to identify brain regions and pathways associated with OAB. However, fMRI is expensive, time-consuming, and requires highly-specialized experts. Thus, a critical research objective is the development of office-based neuroimaging technologies to improve OAB phenotyping. Our multi-disciplinary research group combining urology, engineering, and neuroimaging expertise has made advances in the development of novel office-based technologies for OAB evaluation. We created a real-time Sensation Meter used during bladder filling. We also developed a novel functional Brain NIRS (fNIRS) protocol that shows localized regions of cortical neuroexcitation in response to bladder filling. Our hypothesis is that fNIRS can be used to identify different patterns of OAB representing new phenotypic subtypes. We will test our hypothesis in two aims. In the first aim, we will identify patterns of neuroexcitation with fNIRS during natural bladder filling in normal men and women with OAB using our established 3-fill hydration protocol. We will then use this information to evaluate age-matched women with OAB. The second aim will compare patterns of neuroexcitation with fNIRS and fMRI during natural bladder filling in women with OAB. Successful completion of this proposal will create new office-based neuroimaging technology using fNIRS that, in combination with our established sensation meter and hydration protocols, can ultimately be used for improved phenotyping of OAB in future studies. The data from this study will be used in subsequent multi-PI R01 proposals to test our fNIRS technology on larger participant groups with varying forms of voiding dysfunction and also to study the acute and chronic effects of OAB treatments on sensation and neuroimaging pathways.