INTRODUCTION:Management of overactive bladder (OAB) has a stepwise approach in adults and children. This does not account for individual patient variations, which may explain suboptimal outcomes in many patients. Distinct OAB profiles, based on patient characteristics, symptoms, urodynamic findings and imaging have been discussed in Part 1. Personalized treatment and escalation pathways based on OAB profiling may lead to faster OAB symptom control and quality of life improvement, reduced cumulative side effects and costs, and improved treatment adherence. METHODS:A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping, and targeting therapy according to urgency type and other characteristics?" The group discussed the current literature on this topic and developed a list of research questions and strategies to help shape the future of the field. RESULTS:Tailored combination of antimuscarinics and/or beta3 agonists, with botulinum toxin A (BTX-A) and/or sacral nerve stimulation (SNS) was considered a high priority research topic. Profile-based individual treatment selection and delivery protocols for BTX-A and SNS are potential means to improve outcomes, as is the early escalation to BTX-A and SNS in the treatment pathway of both adults and children. Finally, phenotype-based treatment requires tight treatment outcome follow-up and possible adjustment (including re-phenotyping) for which tools need to be developed. CONCLUSION:Development and validation of a patient-based flow-chart to replace the current stepwise approach in OAB management will allow tailored treatment, aimed to improve therapeutic success, and to reduce side effects.

Objective: Overactive bladder (OAB) is characterized by urinary urgency. To better characterize the relationship between bladder sensation and urgency, a tablet-based "Sensation Meter" was developed to enable construction of bladder sensation-capacity curves. The objective of this study was to correlate sensation-capacity curve shapes during urodynamics (UDS) with urgency severity and bother. Methods: Individuals with moderate-to-severe urgency presenting for clinically indicated UDS were prospectively enrolled after urgency characterization using the International Consultation on Incontinence OAB questionnaire (ICIq-OAB). Throughout UDS filling, participants recorded sensation of bladder fullness (0-100 %) using the Sensation Meter. Sensation-capacity curves were constructed and area-under-the-curve (AUC) analysis was implemented to differentiate between three curve-shape patterns defined as r, l, and j-shape. Curve shapes were correlated categorically to urgency severity and bother, UDS capacity, and the presence/absence of DO. Findings: The study included 69 participants (52F, 17M). The distribution of sensation-capacity curve shapes was 7 (10 %) r-shape, 43 (62 %) l-shape, and 19 (28 %) j-shape. A j-shaped curve was significantly associated with severe urgency and with high urgency bother, but not with bladder capacity or DO. Conclusions: The key finding was the association between a j-shaped sensation-capacity curve, demonstrating a rapid acceleration of sensation near the end of filling, with both urgency symptom severity and bother. Curve shapes were not associated with bladder capacity or DO, suggesting that a j-shaped curve may potentially identify a separate driver of urinary urgency. Additional studies are needed to determine whether sensationcapacity curves can be used to identify novel OAB/urgency phenotypes or guide therapy.

BACKGROUND:Urodynamics has seen, in common with any medical field reliant upon technology, many recent advances in the application of innovations. Novel and effective ideas have been developed and marketed, but relatively few have been incorporated into clinical practice. METHODS:A debate held at the International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK, in June 2025 looked at new technology and its possible inclusion into the patient pathway. RESULTS:Discussion acknowledged that new ideas have not always been comprehensively examined, assessed, or applied. The meeting considered ways to rectify this gap and proposed research that is needed to give evidence-based take-up of innovation in this field. CONCLUSIONS:We propose a tool that examines the time, costs, and a test's specificity and sensitivity for each patient group, to suggest an optimal pathway for that group. The meeting also concluded that techniques involving ultrasound and catheter-free monitoring hold promise and proposed research needed to promote the take-up of innovation in this field.

INTRODUCTION:The management and interpretation of big data appears to be an increasingly attractive but challenging issue in functional urology. The International Continence Society (ICS) Global Urodynamics (UDS) Data Repository (GUDRep) project aims to record and analyse UDS data to share research and clinical information about UDS. OBJECTIVES:The aim of this Think Tank was to identify the main research questions and critical issues related to the GUDRep project. METHODS:This article reports and summarises the discussions on the GUDRep from the 2025 meeting of the International Consultation on Incontinence-Research Society (ICI-RS). RESULTS AND CONCLUSIONS:Several research questions on the GUDRep project need to be considered, including both issues/barriers in building the Repository and economic, clinical and research advantages which could potentially be obtained by the GUDRep itself.

INTRODUCTION:Artificial intelligence (AI) is poised to improve the diagnosis and management of lower urinary tract dysfunction (LUTD). Its effective deployment requires prioritization, regulatory oversight, rigorous validation, and clinician and patient engagement. METHODS:The Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 evaluated key considerations for successful AI implementation into LUTD clinical care. The topics included clinical triage framework, regulatory and legal principles, levels of evidence required for validation, and clinician and patient engagement to guide development. The group developed a narrative of the pressing matters related to AI implementation and a list of proposed research questions, which, when addressed, will help shape the future of the field. RESULTS:LUTD topics that should be prioritized for AI implementation include high-burden conditions with high unmet need such as neurogenic LUTD, bladder outlet obstruction, and overactive bladder. Regulatory frameworks such as the EU AI Act and the U.S. "Software as a Medical Device" and its associated guidance promote safety, transparency, and accountability. AI solutions should be as rigorously evaluated as other clinical devices or drug agents. Patient and clinician engagement are paramount to ensure innovation aligns with the pressing needs of patients and clinicians. CONCLUSIONS:AI's integration into LUTD care requires cross-disciplinary collaboration, prospective validation, and legal and ethical frameworks. AI must be developed and implemented with a strong focus on transparency, trust, and patient-centered care. CLINICAL TRIAL REGISTRATION:This study is not a clinical trial and thus does not warrant registration as such.

INTRODUCTION:Functional near infrared spectroscopy (fNIRS) is a noninvasive technique for measuring cortical brain neuroexcitation. OBJECTIVE:The objective of this study was to determine if fNIRS could detect differences in prefrontal cortex (PFC) neuroexcitation due to acute ON/OFF changes in sacral neuromodulation (SNM) during natural bladder filling. STUDY DESIGN:Female participants who had an SNM device implanted for ≥6 months underwent a 2-fill natural hydration protocol in this cross-sectional study. Continuous oxygenated hemoglobin (O2Hb) concentration was recorded using an fNIRS headcap as a measure of neuroexcitation. Sacral neuromodulation devices were acutely changed from ON to OFF and OFF to ON in 3-minute cycles. One-minute segments of fNIRS signals before and after acute modulation were selected and linear fitting was used to output slope. Two-minute control periods at a similar level of bladder sensation were used for comparison. RESULTS:Twelve women completed the study and median time from SNM implant was 13 (6, 42) months. In the left and middle PFC regions, there was a significant alteration of fNIRS slope (∆O2Hb/time) from baseline to postactivation (OFF to ON) compared to control periods. The first deactivation (ON to OFF) showed continuation of the prior fNIRS slope. The control segments showed stability of averaged O2Hb signals regardless of sensation in all brain regions. CONCLUSIONS:This study indicates that fNIRS may be a useful tool to assess acute changes in neuroexcitation of the PFC in response to SNM device activation in female patients with overactive bladder. The results suggest that SNM may acutely affect the PFC during bladder filling.

Introduction Overactive bladder (OAB) is defined as urinary urgency, usually accompanied by increased daytime frequency and/or nocturia, with urgency urinary incontinence (OAB-wet) or without (OAB-dry), in the absence of urinary tract infection or other detectable disease. The key symptom of OAB, urinary urgency, is defined as a complaint of sudden, compelling desire to pass urine which is difficult to defer. However, patients report a range of individual experiences and sensations associated with urgency and studies have identified different types of urgency. Patients with OAB not only differ in clinical presentation, but also have different urodynamic and radiological findings. These variations may explain why OAB treatments work well for some individuals but not others. This paper investigates how knowledge can be advanced by phenotyping OAB by urgency symptom variation, and clinical, urodynamic measurements and radiological features.Methods A Think Tank at the International Consultation on Incontinence-Research Society (ICI-RS) 2025 discussed the question, "Can OAB management be improved by phenotyping if there are different types of urgency?" The group discussed the current literature on this topic and developed a list of research questions to help shape the future of the field.Results Clinical, urodynamic and radiological phenotyping of urgency were discussed and research studies to phenotype urgency were proposed.Conclusion Further research to phenotype OAB beyond the presence or absence of urgency and urgency urinary incontinence, using clinical, urodynamic measurements and radiological features, is needed. High priority research questions and strategies were defined. Advanced OAB phenotyping may guide tailored management beyond a stepwise approach, with the aim to improve therapeutic outcomes. This would validate phenotyping and is explored in Part 2 of the topic.

ABSTRACTIntroduction and ObjectiveObservable autonomous rhythmic changes in intravesical pressure, termed bladder wall micromotion, is a phenomenon that has been linked to urinary urgency, the key symptom in overactive bladder (OAB). However, the mechanism through which micromotion drives urinary urgency is poorly understood. In addition, micromotion is inherently difficult to study in human urodynamics due to challenges distinguishing it from normal cyclic physiologic processes such as pulse rate, breathing, rectal contractions, and ureteral jetting. Therefore, the goal of this study was to create a reproducible model of micromotion using an ex‐vivo perfused porcine bladder, as well as to describe the relationship between micromotion and afferent nerve signaling.MethodsPorcine bladders were reanimated using ex‐vivo perfusion with a physiologic buffer. The pelvic nerve adjacent to the bladder was dissected, grasped with micro‐hook electrodes and electroneurogram (ENG) signals were recorded at 20 kHz. Bladders were catheterized and intravesical pressure measurements were taken using a Laborie XT Urodynamics system. Bladders were filled to a fixed volume of 300 mL and control measurements were recorded. The bladders were then washed with 0.001 M carbachol (CCh) solution and refilled to 300 mL to induce micromotion, which was detected as rhythmic changes in intravesical pressure. ENG amplitude was calculated in μV, and nerve firing rate was calculated as number of spikes above baseline threshold per minute.ResultsMicromotion was induced by carbachol in 12/25 (48.4%) of trials as rhythmic changes in intravesical pressure after the instillation of carbachol but not in any control period. A fast Fourier transform (FFT) algorithm showed average peak dominant frequency component amplitude was significantly higher during the carbachol period when compared to the control period (0.47 vs. 0.01 cm‐H2O, p < 0.0001). Peak waveform frequency (1.13 vs. 1.54 cycles/min, p > 0.05) did not differ between control and carbachol periods. With regard to afferent nerve signaling, normalized average amplitude (0.66 ± 0.24 vs. 0.05 ± 0.08 μV) and firing rate (0.68 ± 0.28 vs. 0.18 ± 0.22 spike/min) for all bladders was significantly greater in the carbachol period when compared to the control period (p < 0.001).ConclusionsMicromotion can be induced using instillation of carbachol in a perfused ex‐vivo porcine bladder. Increased afferent nerve firing is observed during periods of micromotion. Thus, micromotion may drive afferent nerve signaling and may potentially contribute to urinary urgency, detrusor overactivity, and OAB. The development of an experimental ex‐vivo porcine model for micromotion provides a reproducible method to study bladder micromotion and its potential role in the pathophysiology of urinary urgency and voiding dysfunction.

This review will focus on the current usage and the potential future applications of new imaging techniques on the horizon to study overactive and neurogenic bladder. Bladder Near-Infrared Spectroscopy (NIRS) has been used to non-invasively identify bladder outlet obstruction, detrusor overactivity, and other forms of voiding dysfunction, but motion artifact has been a limiting factor preventing widespread adaptation. However, newer NIRS units employ accelerometers which enable isolation and splicing of motion and on-going studies show renewed promise for bladder NIRS. Ultrasound has been successfully used to evaluate bladder outlet obstruction and other forms of LUT. Techniques including m-mode evaluation of micromotion, as well as the assessment of bladder wall thickness, bladder weight, shape/circularity, vibrometry, and elastography have been explored. Dynamic bladder functional magnetic resonance imaging (fMRI) is the newest bladder imaging technology on the horizon and provides a novel method to assess bladder function alongside real-time high-resolution 3D anatomic images. Bladder imaging techniques including NIRS, ultrasound, and functional fMRI have been developed and are now being used as noninvasive techniques that could potentially supplement, or even replace, traditional Urodynamics.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neuromodulation (PD59)1 May 2024PD59-09 NEAR INFRARED SPECTROSCOPY (NIRS) CAN DETECT ACUTE SACRAL NEUROMODULATION ADJUSTMENTS IN THE ANTERIOR BLADDER WALL AND THE PREFRONTAL CORTEX Linda S. Burkett, Alice Strawn, Brendan McCormack, Mina Ghatas, Luc Mortemousque, Justin Dare, Ryan W. Fogg, Lynn Stothers, John E. Speich, and Adam P. Klausner Linda S. BurkettLinda S. Burkett , Alice StrawnAlice Strawn , Brendan McCormackBrendan McCormack , Mina GhatasMina Ghatas , Luc MortemousqueLuc Mortemousque , Justin DareJustin Dare , Ryan W. FoggRyan W. Fogg , Lynn StothersLynn Stothers , John E. SpeichJohn E. Speich , and Adam P. KlausnerAdam P. Klausner View All Author Informationhttps://doi.org/10.1097/01.JU.0001009544.34256.8a.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Sacral neuromodulation (SNM) targets the S3 sacral nerve and the proposed mechanistic pathways link SNM effects on filling/voiding to neuroplasticity involving the prefrontal cortex (PFC) and bladder sympathetic control. The purpose of this study was to determine if non-invasive standard Near Infrared Spectroscopy (NIRS) and functional NIRS (fNIRS) could detect acute changes in SNM (OFF-ON) in anterior bladder wall hemodynamics and PFC neuroexcitation, respectively, during natural bladder filling. METHODS: Participants treated with SNM (implanted >6 months) with medication-refractory overactive bladder (OAB) completed a natural filling protocol using a Sensation Meter to record bladder sensation from 0-100% fullness. Continuous PFC and bladder oxyhemoglobin (O2Hb) were recorded, Fig 1a. Upon reporting "first desire to void", each patient's SNM unit was adjusted between OFF and ON (3-minute intervals) until 100% sensation (capacity). Surveys for urgency (ICIQ-OAB) and demographic variables were compared. RESULTS: A total of 10 device adjustment cycle pairs were completed with six women (mean age: 61.5±14.7 years and mean BMI: 33.0±10.8). The median time from implantation of SNM was 42 months and the mean total OAB score was 18.5±11.2. Anterior bladder wall O2Hb decreased or remained constant in 90% of OFF-ON cycles, Fig 1b. This demonstrates a slowing of the expected increasing oxygen requirement during filling. In all PFC brain regions, for most cycles, there was a deactivation of neural excitation from OFF-ON (Right 100%, Middle 70%, Left 80%). In 23/30 (77%) of OFF segments, there was increasing or stabilizing O2Hb. Therefore, SNM may potentially reduce O2Hb requirements in tissue during filling, Fig 1c. CONCLUSIONS: Standard NIRS and fNIRS application can detect changes in O2Hb during natural filling in the anterior bladder wall and PFC induced by acute SNM adjustments. These changes suggest SNM affects both the bladder and PFC in voiding control. When SNM was adjusted to ON, participants with OAB demonstrated consistent dampening of increasing O2Hb associated with urgency. Future confirmatory studies are needed, but this study shows that NIRS and fNIRS can potentially be developed to optimize SNM treatment. Download PPT Source of Funding: NIH-R21DK128649, NIH-K12HD108269 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1224 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Linda S. Burkett More articles by this author Alice Strawn More articles by this author Brendan McCormack More articles by this author Mina Ghatas More articles by this author Luc Mortemousque More articles by this author Justin Dare More articles by this author Ryan W. Fogg More articles by this author Lynn Stothers More articles by this author John E. Speich More articles by this author Adam P. Klausner More articles by this author Expand All Advertisement PDF downloadLoading ...