Think tank emphasizes the need for phenotyping patients with OAB

Profiling people with lower urinary tract (LUT) symptoms such as overactive bladder could lead to more personalized therapy, says a think tank.

On behalf of the International Consultation on Incontinence Research Society, experts discussed how to investigate LUT dysfunctions following a review of the literature, focusing on the use of urodynamic studies (UDS), functional neuroimaging, and urinary biomarkers and the microbiome. The outcomes of these discussions were reported in Neurourology and Urodynamics in August 2024

The experts note that UDS are not generally used in the initial diagnosis of OAB because the “data does not alter the outcome of the first-line treatments.” However, they suggest that they can “improve the quality of the diagnosis,” in terms of the specific type and phenotype of OAB, “thus allowing a tailored treatment to the specific form.” 

They cite research in their article that indicated selection of treatment based on UDS improved the outcome of treatment resulting in “significantly higher cure and satisfaction rates.”

The think tank members Enrico Finazzi Agrò (University of Rome Tor Vergata, Italy) and colleagues also highlight the importance of functional neuroimaging in improving understanding of LUT heterogeneity, notably in assessing the visceroceptive processes that cause LUT sensation and control. This contrasts with “subjectively reported sensory experiences, which currently constitute the basis for diagnostic protocols and the evaluation of treatment efficacy,” they say.

The team believes that advancing functional neuroimaging protocols “is an essential step toward identifying predictive factors for treatment effectiveness.”

Specifically, the group refer to recent functional magnetic resonance imaging studies that have shown differences between people with and without OAB in terms of short- and long-range functional connectivity patterns in areas of the brain involved in LUT sensation and control. And assessment of these patterns enabled responders to treatment to be distinguished from nonresponders.

Similarly, recent advances in ultrahigh field scanners have enabled investigation of small brain stem nuclei including the periaqueductal gray, which has been shown to be involved in OAB and it may be that sacral nerve stimulation (SNS) manipulates activity in this area of the brain to cause a treatment effect.

Therefore, “[neuroimaging presents a tool to improve therapeutic strategies such as SNS by measuring [central nervous system] responses associated with the stimulation of sensory sacral nerve fibrers,” say Agrò and team. 

They propose that functional neuroimaging “will improve patient characterization and diagnostic procedures and will facilitate the identification of predictive factors associated with therapeutic effectivity.”

Neither biomarkers nor microbiome are included in the diagnostic workup of patients with OAB, and the think tank members say more needs to be done to better understand their role. Currently, a lack of standardization of study designs and differences in patient characteristics (eg, age, antibiotic use, and hormonal status) and urine sampling and processing methods (eg, catheter, suprapubic aspirate, voided urine, renal aspirate) make this difficult, they comment.

Biomarkers that have been studied include most commonly nerve growth factor and urinary brain-derived neurotrophic factor, and their association with OAB has been inconsistent depending on the quality of the study.

Urine microbiomes have been studied but with no consensus on an association with any LUT, the authors note, although they say that further investigation in studies with longitudinal sampling that control for confounding factors is needed.

“Real data monitoring utilizing advanced but standardized biomarker and imaging technology is essential for ensuring accurate and reproducible results that could be translated into clinical practice,” says the group.

Recommending areas for future research, they suggest the need for symptomatologic questionnaires on specific phenotypes, functional neuroimaging protocols for quantifying LUT sensation and control, and new neuroimaging tools, as well as investigation into how treatments work in specific subgroups of patients – children, men, women, neurologic patients – and the impact of parameters such as urodynamic patterns and biomarkers on LUT dysfunction and its treatment.

News stories are provided by medwireNews, which is an independent medical news service provided by Springer Healthcare Ltd. © 2024 Springer Healthcare Ltd, part of the Springer Nature Group

Read the article here: Neurourol Urodyn 2024: 43; 1272–1282

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