title: Protocol for a prospective magnetic resonance imaging study on supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity.
abstract: BACKGROUND
  The control of the lower urinary tract is a complex, multilevel process involving both the peripheral and central nervous system. Due to lesions of the neuraxis, most spinal cord injury patients suffer from neurogenic lower urinary tract dysfunction, which may jeopardise upper urinary tract function and has a negative impact on health-related quality of life. However, the alterations to the nervous system following spinal cord injury causing neurogenic lower urinary tract dysfunction and potential effects of treatments such as intradetrusor onabotulinumtoxinA injections on lower urinary tract control are poorly understood.
  
  
  METHODS
  This is a prospective structural and functional magnetic resonance imaging study investigating the supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity.Neuroimaging data will include structural magnetic resonance imaging (T1-weighted imaging and diffusion tensor imaging) as well as functional, i.e. blood oxygen level-dependent sensitive magnetic resonance imaging using a 3 T magnetic resonance scanner. The functional magnetic resonance imaging will be performed simultaneously to three different bladder stimulation paradigms using an automated magnetic resonance compatible and synchronised pump system.All subjects will undergo two consecutive and identical magnetic resonance imaging measurements. Healthy subjects will not undergo any intervention between measurements but spinal cord injury patients will receive intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity.Parameters of the clinical assessment including bladder diary, urinalysis, medical history, neuro-urological examination, urodynamic investigation as well as standardised questionnaires regarding lower urinary tract function and quality of life will serve as co-variates in the magnetic resonance imaging analysis.
  
  
  CONCLUSIONS
  This study will identify structural and functional alterations in supraspinal networks of lower urinary tract control in spinal cord injury patients with neurogenic detrusor overactivity compared to healthy controls. Post-treatment magnetic resonance imaging measurements in spinal cord injury patients will provide further insights into the mechanism of action of treatments such as intradetrusor onabotulinumtoxinA injections and the effect on supraspinal lower urinary tract control.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01768910.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Leitner
authors.forename: Matthias
authors.initials: M
authors.lastname: Walter
authors.forename: Patrick
authors.initials: P
authors.lastname: Freund
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mehnert
authors.forename: Lars
authors.initials: L
authors.lastname: Michels
authors.forename: Spyros
authors.initials: S
authors.lastname: Kollias
authors.affiliation: Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland. tkessler@gmx.ch.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D008279:Magnetic Resonance Imaging; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D014551:Urinary Tract / Q000473:pathology* / Q000503:physiopathology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A