Advanced Imaging for the Assessment of Lower Urinary Tract Symptoms
Description
Summary
Lower urinary tract symptoms (LUTS) affect millions of aging men and range from weak or hesitant urine flow to nocturia and incomplete bladder emptying. Left unaddressed, these symptoms can progress to more serious bladder dysfunction, including urinary retention, infections, bladder stones, and kidney damage. Current treatments mainly target hormonal activity and muscle tone in the prostate, improving flow but failing to help all patients or halt disease progression—suggesting that other underlying processes, particularly inflammation and fibrosis, play a meaningful role. Chronic inflammation triggers abnormal tissue repair, leading to scarring, collagen buildup, and stiffening that impairs organ function, a pattern seen not just in the prostate but in conditions like heart disease and liver disease. Despite this, tools to noninvasively detect prostate inflammation and fibrosis are lacking: imaging like ultrasound and MRI shows anatomy but not tissue stiffness, urodynamic testing evaluates bladder function without imaging the prostate, and biopsy is invasive and rarely used for this purpose.
Elastography techniques—magnetic resonance elastography (MRE) and ultrasound-based shear wave elastography (SWE)—offer a way to measure tissue stiffness noninvasively, similar to a physical exam but quantified. Both methods generate mechanical waves in tissue (via an external driver for MRE or focused sound energy for SWE) and track how fast those waves travel, since stiffer tissue transmits waves differently than softer tissue; specialized software then converts this into stiffness maps measured in kilopascals. These techniques have proven valuable in the liver, where elevated stiffness reliably signals fibrosis and MRE can reveal uneven patterns of scarring that biopsies might miss due to sampling limitations. Separately, the researchers note that bladder dysfunction tends to develop gradually and is often diagnosed only after complications like infection or kidney trouble arise. Their own work has found that asymmetric, poorly coordinated bladder muscle contractions—possibly driven by autonomic nervous system dysfunction—may impair effective voiding, causing the bladder to overwork itself and eventually decompensate.
Details
This research aims to characterize age-related changes in the prostate and bladder in men with lower urinary tract symptoms (LUTS) using novel quantitative MRI techniques adapted from cardiac and liver imaging. The approach non-invasively measures 3D anatomy, tissue composition, stiffness, and function of the prostate and bladder during voiding. For the prostate, the near-term goal is to understand how tissue stiffness, inflammation, and fibrosis relate to bothersome symptoms, with an eye toward using MRE or SWE to monitor treatment response and help guide decisions between surgical and non-surgical care. Researchers plan to correlate prostate mechanical properties with symptom scores and other imaging features—such as bladder wall structure, prostate volume, and perfusion/diffusion patterns linked to fibrosis—ultimately aiming to develop an imaging-based device for measuring prostate stiffness that could support future clinical trials.
For the bladder and urethra, the work addresses key limitations of current urodynamic testing, which measures pressure and flow but cannot assess the coordination of bladder muscle contraction or bladder neck movement in three dimensions, and remains invasive without imaging the prostate directly. Multiparametric MRI and MR urodynamics offer a non-invasive alternative capable of 3D, quantitative assessment of bladder wall motion, potentially becoming a standard tool for diagnosing the causes of LUTS—such as underactive bladder, outflow obstruction, or overactive bladder—and guiding treatment. By studying patients before and after surgery, the research seeks to clarify how anatomical and functional changes in the bladder relate to surgical improvements in urine flow, supporting more personalized treatment approaches. Overall, the novelty lies in adapting well-established MRI methods from liver and cardiac imaging to comprehensively and non-invasively evaluate prostate and bladder structure and function.
The PRIMARY OBJECTIVE is to develop and validate advanced imaging (MRI and US) techniques for the characterization of the normal and ageing prostate and the associated changes that occur in the bladder that contribute to LUTS. Also, to develop strategies for early diagnosis and intervention that will facilitate the development of effective medical treatments to prevent the progression to end-stage bladder dysfunction. We will:
1. Perform mpMRI and quantitative US to characterize prostate size and morphology, tissue signatures associated with unique histologies, tissue stiffness and MRU and US to characterize bladder wall motion coordination, symmetry and calculated efficiency of the detrusor contraction, bladder base and funneling of the neck and other metrics that define voiding and micturition.
2. Compare bladder wall motion and coordination, symmetry, and calculated efficiency of the detrusor contraction, bladder base and funneling of the bladder neck using previously defined quantitative metrics obtained with MRI and dynamic MRU during voiding in men and women with LUTS and healthy controls.
3. Perform anatomic and quantitative MRI of the body to measure features of metabolic health including visceral and subcutaneous fat, liver fat fraction, muscle volume and fat fraction.
4. Correlate quantitative features obtained from the prostate and bladder with validated symptom scores, available specimens (PSA, urine samples, bladder and prostate histology) and current/past medical history (including medications and herbal therapies) and clinical and imaging features of metabolic health (diabetes, cholesterol profile, BMI, abdominal circumference, etc.)Number of Participants
This is a multi-site study, 300 subjects are expected to participate overall, 100 subjects will be healthy subjects and 200 subjects with LUTS.
Participants
Men between the ages of 18-85 experiencing symptoms of LUTS.
Exclusion:
If the patient has a contraindication to MRI (e.g. pacemaker, contraindicated metallic implants, claustrophobia, etc).
If the patient has a history of pelvic surgery including prostate, bladder or urethral interventions or radiation.
Contrast will not be used if you have a history of severe renal/kidney disease or allergy to gadolinium based contrast agents.
