Brain Imaging in Men With Lower Urinary Tract Symptoms
Brain Imaging in Men With Lower Urinary Tract Symptoms
Benign Prostatic Hyperplasia (BPH) affects the storage and voiding phases of the micturition
 cycle. Lower urinary tract symptoms (LUTS) refers to storage symptoms such as urinary
 frequency, urgency, urge urinary incontinence and nocturia. Surgical options for bladder
 outlet obstruction (BOO), including prostate ablation and transurethral resection, are
 currently offered for symptomatic improvement. However, 30% of patients report persistent
 LUTS after BOO procedures. Neuroplasticity induced by BPH and BOO can be contributory of
 persistent LUTS in these men, having different brain activation patterns during the
 micturition cycle. The investigators proposed unique multimodal functional Magnetic Resonance
 Imaging (fMRI) study that will identify for the first time, structural and functional brain
 contributions to LUTS in men with BPH and BOO at baseline and following BOO procedures. The
 investigators hypothesize that men with symptomatic BPH who have persistent LUTS following
 BOO procedures have a distinct brain activation pattern in Regions of Interest (RoI) that
 regulate the micturition cycle.
The investigators propose a unique, multimodal prospective study that will allow
 investigators to identify for the first time the structural and functional brain
 contributions to LUTS in men with BPH and BOO at baseline and post procedure. For this, The
 investigators will recruit three different groups of patients:

 Group 1: Patients with BPH and significant improvement in the storage symptoms following BOO
 procedures.

 Group 2: Patients with BPH who have persistent storage symptoms following BOO procedures.

 Group 3 (CONTROL GROUP): Men without LUTS who are planning to undergo radical prostatectomy.

 Each participant will provide a detailed history, undergo a complete physical examination and
 will have the following assessments: IPSS, IPSS Quality of life, Incontinence Severity Index
 (ISI), Patient Global impression of severity (PGI-S) and improvement (PGI-I)19, 20,
 International Index of Erectile Function (IIEF-5), MRI Safety Screening Questionnaire. A post
 void residual volume will be measured and a urine sample will be obtained for urinalysis
 (patients and controls). A two-day bladder diary will also be obtained from the participants.
 Participants in group 1 and 2 will undergo a clinical urodynamic study within a year prior to
 the neuroimaging scan. All participants will be followed up at one, three and six months
 after the BOO procedures (Transurethral resection/ablation of prostate and simple
 prostatectomy) and radical prostatectomy in the control group. On each visit, the
 investigators will gather the following data: Uroflow and PVR assessment, bladder diary, and
 all questionnaires will be repeated in all patients at one, three, and six months.
 Participants with persistent storage LUTS at six months will have a repeat UDS to ensure BOO
 is resolved. Group 1 and 2 will undergo simultaneous fMRI/UDS scanning twice during this
 study: First before BOO procedures and at the second one at six months. The control group
 will undergo baseline fMRI/UDS.

 Investigators' established platform for simultaneous urodynamic study and functional MRI
 scanning will allow investigators to detect structural changes during the micturition cycle.
 Providing 3D structural images and functional images to have a better understanding of the
 brain effect on LUTS. By correlating the bold signal changes, structural markers and
 participant's clinical data, investigators will provide scientific rationale for subsequent
 studies in the field of neurourology.
Inclusion Criteria:

 -  Controls (n=13) Men older than 45 years undergoing radical prostatectomy without LUTS

 -  IPSS (International prostate symptom score lower than 12)

 -  Nocturia equal or less than 2 on a two day bladder diary

 -  Group 1 (n=18) Men older than 45 with improved LUTS after 6 months of a BOO procedure
 and IPSS less than 12

 -  Improvement in IPSS in at least 3 points for storage symptoms

 -  Nocturia equal or less than 2 on a two day bladder diary

 -  Group 2 (n=9) Men older than 45 with persistent LUTS at six months post BOO procedure

 -  IPSS higher than 8

 -  Nocturia more than 2

 -  Delta change in IPSS score less than negative 3 points

 Exclusion Criteria:

 -  Men with

 -  Neurogenic bladder

 -  Urethral stricture

 -  Prior BOO procedures

 -  History of urinary retention with indwelling foley catheter or intermittent
 catheterization Additional exclusion criteria for Group 1 and 2 (Subjects with BPH and
 LUTS)

 -  History of bladder cancer within 5 years

 -  History of treatment for prostate cancer other than active surveillance

 -  Intradetrusor injection of BTX-A within 9 months prior to screening for any urological
 condition