Neuro-Urology Laboratory
Led by Arthur L. Burnett, M.D., the Basic Science Laboratory in Neuro-Urology focuses on biological mechanisms of the pelvis as they relate primarily to erectile dysfunction and voiding dysfunction (urinary incontinence).
We aim to understand the neurophysiology and vascular physiology of the lower genitourinary tract, with an emphasis on the translational aspect of basic science discoveries relevant to the human condition. Overall, the laboratory is geared toward improving and preserving erectile and voiding dysfunctions, which occur as a result of pelvic disorders and consequences from treatment of these disorders.
Open Clinical Trial: Automated Intraoperative Monitoring to Improve Functional Outcomes following Radical Prostatectomy
Study Objectives: Our primary objective is to develop an automated method to monitor neurovascular structures at surgical risk during RP. To achieve this objective, we will develop the software that will automatically administer a multimodality monitoring program continuously during RP. This type of monitoring has never been performed before as it is very innovative.
Our secondary objective is to develop algorithms that will allow our automated monitoring platform to be used in other high-risk surgeries that are either not currently being monitored or are monitored in only urban areas and in high-income zip codes.
To achieve these Objectives, we have developed three Specific Aims:
- To record baseline data during RP.
- Analyze Baseline data for normal variability; determine effects from anesthesia and core temperature on data; compare baseline data to traditional non-RP interpretation criteria.
- Determine the most sensitive interpretative criteria; incorporate these criteria into our interpretative algorithm; administer automated monitoring program to remaining subjects during RP.
Main Eligibility Criteria:
Inclusion Criteria:
- Male subjects 40-70 years of age diagnosed with adenocarcinoma of the prostate
- Subjects scheduled for open or robotic assisted radical prostatectomy for removal of localized prostate cancer
- Subjects demonstrate a pre-operative score of 22 or higher on the IIEF questionnaire.
- Subjects, who, in the opinion of the Clinical Investigator, are able to understand this clinical investigation, cooperate with the investigational procedures and who are willing to participate in all the required post-treatment follow-up questionnaires.
Exclusion Criteria:
- Subjects with a primary Gleason score equal to or greater than 4
- Subjects with pre-operative urinary incontinence defined as use of pads or adult diapers
- Subjects with previous pelvic or abdominal radiation therapy
- Subjects with current or previous malignancy other than prostate or non-melanoma skin cancer
- Subjects who have previously had a transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP), high intensity focused ultrasound (HIFU) or cryotherapy
- Subjects with a prostate volume of >80 mL
- Subjects with a body mass index (BMI) of ≥ 34
- Subjects with current or suspected urinary tract or bladder infection(s)
- Subjects with reported unstable cardiovascular disease (e.g., unstable angina, myocardial infarction within past 6 months, cardiac failure or life-threatening arrhythmia, congestive heart failure) or symptomatic postural hypotension within 6 months before screening
- Subjects with drug, alcohol, or substance abuse reported within the last three years (subject reported);
- Subjects with a life expectancy less than study duration
- Subjects with systemic autoimmune disorder
- Subjects with any significant psychological disturbance that, in the opinion of the Investigator, could impair the consent process or ability to complete self-assessment questionnaires
- Subjects with known sensitivity to any device or products required for intraoperative monitoring
- Subjects with any other condition that would contraindicate participation, as determined by the investigator.
Principal investigator: Dr. Arthur Burnett
Scientific Areas of Study
Neurophysiology of the Pelvis
Principal research studies have focused on the neurophysiology of the pelvis along with molecular mechanisms largely specific to nerve regulation of erectile and voiding functions.
This work led to the original discovery that nitric oxide is the principal neurotransmitter regulating penile erection. The discovery contributed to an understanding of the science of penile erection in the early 1990’s, from which drugs such as Viagra, Levita and Cialis were developed.
The laboratory has continued major studies in the areas of nitric oxide biology in the pelvis as they relate to other erection disorders such as priapism, a condition of prolonged penile erection.
Improving Outcomes of Radical Prostatectomy
Over the past several years, the lab has focused on improving outcomes of radical prostatectomy related to the recovery of urinary and erectile functions. Primary efforts have gone toward the investigation and development of chemical compounds for men undergoing radical prostatectomy — in hopes that erectile function will be better preserved.
In collaboration with Johns Hopkins neuroscientists, the lab has established a role for neuroimmunophilins, which are special proteins localized to nerves. Neuroimmunophilins appear to be the receptor molecules for specialized drugs that can be taken to protect the nerves from significant damage.
Experimental models in rats with nerve injury leading to erectile dysfunction — similar to what occurs in men after radical prostatectomy — have been used to demonstrate the major potential for drugs based on this pathway to be developed and used in the near future.
Ongoing projects have involved the study of additional drugs that may help recover penile nerve function in men undergoing radical prostatectomy.
Research Training Opportunities
We welcome both graduate and undergraduate students to participate in research activities:
- Medical students – Please consider joining the laboratory for an elective rotation, even for a short period of time.
- Post-doctoral fellows – Please consider the laboratory for further research development in the areas of pelvic neurophysiology and vascular biology.
For more information, contact Dr. Burnett directly at [email protected].
Our Team
Laboratory Director
Arthur L. Burnett, M.D., has served as director of the Basic Science Laboratory in Neuro-Urology for more than 10 years. He is a professor of urology at the Johns Hopkins School of Medicine, director of the Male Consultation Clinic at Johns Hopkins Hospital, and a clinician-scientist at the James Buchanan Brady Urological Institute.
Research Team
- Biljana Musicki, Ph.D., Research Associate
- Liming Jin, Ph.D., Research Associate
- Tongyun Liu, Senior Research Technician
- Gwen Lagoda, Senior Research Technician
Our laboratory frequently is joined by post-doctoral fellows, graduate students and undergraduate students. We also partner with other experts in the Department of Urology, as well as scientists in the departments of neuroscience, cardiology and psychiatry.
Contact Us
The Department of Urology
JHH-407 Marburg 21287
Fax: 410-614-3695
E-mail: [email protected]