Houston Methodist researchers have been awarded a five-year, $3.28 million grant from the National Institutes of Health to study how the brain controls bladder storage and emptying in people with underactive bladder, a condition that can make urination difficult or impossible and leave patients with few effective treatment options.

 

 Dr. Rachel High, research director of the Center for Restorative Pelvic Medicine and professor of Obstetrics & Gynecology and Urology at Houston Methodist, is the study’s principal investigator, while Dr. Rose Khavari, professor of urology at Houston Methodist Research Institute will serve as the co-principal investigator.

 

Underactive bladder affects men and women and becomes more common with age. Patients may be unable to urinate, spend extended periods trying to empty their bladder or continue to feel that their bladder is full. Incomplete emptying can also contribute to urinary frequency and leakage. Treatment options are limited, and many patients do not get adequate relief from existing therapies.

 

“Effective treatments for underactive bladder are lacking,” High said. “In practice, we see many underactive bladder patients who failed all treatments and commit to long-term catheter use. Treatment options are limited by a lack of understanding of all the factors that cause underactive bladder, and this is our first step toward developing a very targeted precision medicine treatment for them.”

 

Researchers will use functional MRI to observe changes in brain activity as the bladder moves through filling, urgency, attempted emptying and post-emptying states. Participants will also complete validated questionnaires and undergo urodynamic testing, which measures bladder pressure and helps clinicians understand the possible causes of urinary symptoms.

 

“This issue has traditionally been viewed primarily as a problem of the bladder itself,” Khavari said. “Aging represents a spectrum of continuous changes, from the end organ to the nervous system and brain. We are taking a broader approach by studying the entire brain-bladder network.”

 

The researchers will compare enrolled groups in the study to identify differences in brain activity associated with bladder storage and emptying. They will also compare the older-adult participants with younger healthy adults to examine how aging may affect brain-based bladder control. Enrollment will include men and women, allowing the investigators to explore possible sex-related differences that have not been well represented in earlier research.

 

Findings from the study are intended to help researchers identify abnormal neurologic activity that could eventually guide targeted neuromodulation therapies.

 

The research builds on previous brain-imaging and noninvasive brain-stimulation work conducted by High and Khavari. The researchers’ other collaborator is Jason Kutch, Ph.D., of the University of Southern California.