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A $1.7 million grant awarded to two Virginia Commonwealth University researchers may lead to improved diagnosis and treatment of overactive bladder – a condition that affects nearly 20 percent of adults and that is characterized by symptoms such as urinary urgency, frequency and incontinence.

The five-year grant, “The Detrusor Tension Sensor: A Model for Novel Cystometrics in Overactive Bladder,” was awarded by the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health in the U.S. Department of Health and Human Services.

“This will hopefully lead to more targeted therapies and improved outcomes for new medications that are used in the treatment of overactive bladder,” said Adam Klausner, M.D., an associate professor and the Warren Koontz Professor of Urologic Research in the Division of Urology/Department of Surgery of VCU’s School of Medicine.

Klausner is one of the grant’s two principal investigators, along with interdisciplinary collaborator John Speich, Ph.D., associate professor and associate chair of the Department of Mechanical and Nuclear Engineering in VCU’s School of Engineering.

For the past 50 years, overactive bladder has typically been diagnosed via an invasive test called urodynamics, in which catheters are inserted to measure the pressure in the bladder.

Under the grant, the researchers are aiming to vastly improve the standard urodynamics testing by adding 2-D and 3-D ultrasound, as well as 4-D ultrasound, which is 3-D ultrasound with the addition of time, much like a pregnancy ultrasound.

“Our new techniques, developed through a collaboration between urology and mechanical engineering, will provide a vast amount of additional information about the filling phase, and may allow us to develop new ways to study the bladder in a noninvasive way, without the need for bladder and rectal catheters,” Klausner said.

The new and improved imaging will give doctors a real-time look at the bladder and provide them with a better understanding of the specific problems being experienced.

“I approach the bladder as a physician and surgeon, and Dr. Speich approaches the bladder as an engineer. Together, we have been able to see the bladder not just as an organ, but as a biomechanical structure,” Klausner said. “Applying state-of-the-art techniques of mechanical engineering to the study of the bladder has allowed us to create new technologies and apply existing technologies to improve our understanding of how the bladder works.”

Together, we have been able to see the bladder not just as an organ, but as a biomechanical structure.

They also plan to develop a specially designed repeat fill protocol, advanced signal analysis and evaluation of real-time bladder sensation using a novel “urgency meter.”

Additionally, the researchers expect to be able to better characterize bladder muscle problems that affect people with overactive bladder. With that improved understanding, they hope to define new subcategories of the condition, thereby allowing physicians to prescribe treatment that more specifically targets the cause of the problem.

As the engineer on the project, Speich’s goal is to help the doctors in the clinic have better tools for analyzing the data they collect so they can make better, more informed decisions about diagnosis and treatment.

Speich will work to develop algorithms to quickly process images, providing physicians with insight into whether the patient is experiencing a “mechanical” problem with the bladder.

Based on pre-clinical research over the past decade, the researchers have identified three biomechanical categories of bladder muscle problems that they believe will be possible to diagnose with their new technologies.

Additionally, they expect to be able to better identify individuals with overactive bladder caused not by biomechanical problems but by psychological factors such as stress, anxiety and depression.

Speich helped develop the improved “urgency meter,” which allows patients to more accurately describe how full their bladder is, providing the physician with more specific information that can be used to diagnose the problem.

“Right now, when they’re [undergoing the urodynamics test], they ask you about what your bladder feels like. And they ask you for three data points – your first sensation, your first desire to empty and when you have a strong desire to empty,” he said. “We’ve developed a meter where we ask them more frequently. So it basically looks like a fuel gauge, going from empty to full.”

A key reason Klausner and Speich received the new grant, they said, is because of a $50,000 grant from VCU’s Presidential Research Quest Fund. That grant, “Mechanical Urgency: Correlation of Novel Bladder Wall Compliance Measurements with Patient-Reported Sensations,” was part of an ongoing initiative by VCU President Michael Rao, Ph.D., to develop and enhance faculty scholarship across the institution.

“We … owe our success to a grant from the VCU Presidential Research Quest Fund which provided the necessary support to acquire the preliminary data needed for our NIH research proposal,” Klausner said. “In our case, Dr. Rao’s vision is truly paying off.”

The researchers also credited their mentor, Paul Ratz, Ph.D., a VCU professor of biochemistry and pediatrics, as well as their collaboration with VCU’s Center for Research Support and research coordinator Kimberly Bradley.

That’s our job, right? Make it real, and help people.

The grant will also involve Laura Carucci, M.D., a radiologist at VCU, who will serve as a research collaborator helping with the ultrasound technology, and Ashley Carroll, M.D., of the Department of Obstetrics and Gynecology/Division of Urogynecology, who will serve as a research collaborator focused on helping to improve enrollment and outreach of the project.

Speich said the project is a great example of VCU’s slogan, “Make it Real.”

“That’s our job, right? Make it real, and help people,” he said. “As engineers, we’re supposed to make things to help people. And to design tools that can help others analyze data and collect data that can help people. So it makes things worthwhile.”

Funding for this work comes from NIH grant number R01DK101719.