To Investigate the role of Urinary Brain Derived Neurotrophic Factor (BDNF) Measurement in the Assessment of Lower Urinary Tract Symptoms in Women

Abstract

Interest in urinary biomarkers has increased over the last few years. Work on urinary neurotrophic factors, particularly nerve growth factor (NGF) has been investigated in lower urinary tract symptoms (LUTS). Urinary brain derived neurotrophic factor (BDNF) is thought to be even more specific than NGF, as a marker of certain lower urinary tract conditions such as overactive bladder (OAB), stress urinary incontinence (SUI) or bladder pain syndrome/interstitial cystitis (BPS/IC). It has been proposed that measurement of urinary BNDF in LUTS is even better at discriminating between different conditions and can also give an indication of disease severity and treatment response. There are limited studies published looking at the role of urinary BDNF measurement in LUTS. The initial part of this thesis provides an overview of the basic science behind BDNF, the published data so far surrounding BDNF, a review of the anatomy and physiology of the lower urinary tract and an overview of methods used to assess LUTS in current clinical practice. The remainder of the thesis aims to determine whether urinary BDNF measurement is of any use in assessing women with LUTS initially determining the test-retest reliability of the measurement technique. I then go on to determine whether it is comparable to other assessment methods including patient centred questionnaires, 3-day bladder diaries and urodynamics. Furthermore, urinary BDNF levels are assessed conditions including overactive bladder, stress incontinence, bladder pain and prolapse. In the last section, the relevance of the study findings is discussed, and the data is pooled with published data for a meta-analysis of BDNF in lower urinary tract symptoms. Final conclusions are made and suggestions for future research considered.