Who we are

We are national leaders in the research field of bladder dysfunction and urinary symptoms that follow nervous system injury or disease. Located at MedStar National Rehabilitation Hospital in Washington, D.C., our team works collaboratively to investigate ways to produce positive patient outcomes.

We are funded by the National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education, Grant #90RTHF0003-01-00. The opinions expressed on these pages are those of the authors, and no official endorsement by the Department of Health and Human Services (HHS) or any other funding source should be inferred.

Research projects

Research Project 1

Intravesical Probiotic (Lactobacillus) for Urinary Symptoms Among People with Neurogenic Lower Urinary Tract Dysfunction Who Use Indwelling Catheters

The objective of this study is to:

  • Look at healthy urine when not experiencing urinary symptoms
  • Estimate the effect of intravesical Lactobacillus GG dose on urinary symptoms

Participants must:

  • Be diagnosed with neurogenic bladder (SCI, MS, SB, stroke, etc.)
  • Use indwelling catheterization for bladder management
  • 18 years or older
  • Have a history of two or more episodes of urinary symptoms in the past year

Objective 1: Participants in the metropolitan Washington, D.C., area will leave two urine samples within two weeks when not experiencing urinary symptoms.

Objective 2: Participants in the metropolitan Washington, D.C., area will be randomized into an intravesical Lactobacillus GG low dose or high dose group. Instillation will occur when experiencing urinary symptoms.

Urine samples may be collected.

If you are interested or have questions, please contact:

Margot Giannetti

Margot.Giannetti@medstar.net

202-877-1071

Research Project 2

A Randomized Controlled Trial of Transcutaneous Tibial Nerve Stimulation (TTNS) for Neurogenic Lower Urinary Tract Dysfunction (NLUTD)

This study seeks to demonstrate that TTNS will improve NLUTD in SCI/D by intervening acutely, improving the quality of life by providing a feasible, non-pharmacologic, and dignified intervention to be performed at home to reduce autonomic dysreflexia.

Participants must be:

  • Diagnosed with a spinal cord injury or disease
  • Level of injury T1-T9
  • Aged 18-65
  • Currently admitted to inpatient within four weeks of SCI/D at either MedStar National Rehabilitation Hospital (Washington, D.C.,) or TIRR Memorial Hermann (Houston, TX)

Participants will be in this study for one year and randomized into a low or high TTNS group.

If you are interested or have questions, please contact:

MedStar National Rehabilitation Hospital

Mandy Rounds, PhD

Amanda.K.Rounds@medstar.net

202-877-1591


TIRR Memorial Hermann

Vanessa Bernal

Vanessa.Bernal@uth.tmc.edu

713-797-7636

Research Project 3

A Mixed Methods Assessment of the Impact of the Connected CatheterTM on Quality of Life and Participation

Study Objective: The primary objective of this study is to evaluate the burden of Neurogenic Lower Urinary Tract Dysfunction (NLUTD) on

  • Health-related Quality of Life (QOL)
  • Participation affected by type of bladder management
  • Determine what constitutes a clinically meaningful difference in Neurogenic Lower Urinary Tract Dysfunction (NLUTD)-related QOL and participation and to identify NLUTD user-defined themes regarding bladder function and catheter-related barriers and the daily impacts on one’s life.

To be included in this study, participants must:

  • Have previous participation in a connected catheter study
  • Be male
  • Be 18 years or older
  • Have a diagnosis of neurogenic lower urinary tract dysfunction

For interviews, caregivers of the above participants will be recruited.

If you are interested or have questions, please contact:

Mandy Rounds, PhD

Amanda.K.Rounds@medstar.net

202-877-1591

Publications

  • The urine microbiome of healthy men and women differs by urine collection method

    Hsieh M, Groah SL. The urine microbiome of healthy men and women differs by urine collection method. Int Neurourology J 2020 (in press)

  • Symptom and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders

    Forster CS, Wang J. Symptom and urinalysis-based approach to diagnosing urinary tract infections in children with neuropathic bladders. Pediatric Nephrology. In press. PMID: 31919595

    https://www.ncbi.nlm.nih.gov/pubmed/31919595

  • The diagnosis of UTI in the neuropathic bladder

    Forster CS, Pohl H. The diagnosis of UTI in the neuropathic bladder: Changing the paradigm to include the microbiome. Topics in Spinal Cord Injury Rehab, 2019, 25(3):222-227. PMID: 31548789.

    https://www.ncbi.nlm.nih.gov/pubmed/31548789

  • A single intravesical instillation of probiotics is safe in children and adults with neuropathic bladder

    Forster C, Hsieh MH, Perez-Losada M, Caldovic L, Pohl H, Ljungberg IH, Sprague B, Stroud C, Groah SL. A single intravesical instillation of probiotics is safe in children and adults with neuropathic bladder: A phase Ia clinical trial. JSCM 2019 (in press)

  • Effects of intravesical Lactobacillus Rhamnosus GG on urinary Symptom Burden in People with Neurogenic Lower Urinary Tract Dysfunction

    Tractenberg RE*, Groah SL*, Frost JK, Rounds AK, Davis E, Ljungberg IH, Schladen MM. Effects of intravesical Lactobacillus Rhamnosus GG on urinary Symptom Burden in People with Neurogenic Lower Urinary Tract Dysfunction. PMR 2019 (under review)

  • Antibiotic prophylaxis prescribing patterns of pediatric urologists for children with vesicoureteral reflux and other congenital anomalies of the kidney and urinary tract

    Hamdy R, Pohl H, Forster CS. Antibiotic prophylaxis prescribing patterns of pediatric urologists for children with vesicoureteral reflux and other congenital anomalies of the kidney and urinary tract. Urology. In press. PMID: 31758980

    https://www.ncbi.nlm.nih.gov/pubmed/31758980

  • The Utility of DNA Next Generation Sequencing and Expanded Quantitative Urine Culture in the Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms

    Gasiorek M, Hsieh H, Forster CS. The Utility of DNA Next Generation Sequencing and Expanded Quantitative Urine Culture in the Diagnosis and Management of Chronic or Persistent Lower Urinary Tract Symptoms. The Journal of Clinical Microbiology. In press. PMID: 31619534

    https://www.ncbi.nlm.nih.gov/pubmed/31619534

  • Intravesical Lactobacillus Rhamnosus GG is Safe and Well-Tolerated in Adults and Children with Neurogenic Lower Urinary Tract Dysfunction

    Groah SL, Rounds AK, Ljungberg IH, Sprague B, Frost J, Tractenberg RE. Intravesical Lactobacillus Rhamnosus GG is Safe and Well-Tolerated in Adults and Children with Neurogenic Lower Urinary Tract Dysfunction: First-in-Human Trial. Ther Adv Urol 2019;11:1-13

    https://www.ncbi.nlm.nih.gov/pubmed/31620195

  • Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation

    Stampas A, Gustafson K, Korupolu R, Smith C, Zhu L, Li S. Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial. Front Neurosci 19;13:119. Feb 2019

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390711/

  • Feasibility of Self-Administered Neuromodulation in Spinal Cord Injury Neurogenic Bladder

    Int Neurourology J Stampas A, Khavari R, Frontera JE, Groah SL. Feasibility of Self-Administered Neuromodulation in Spinal Cord Injury Neurogenic Bladder. Int Neurourology J 2019 Sep;23(3):249-256.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790819/

  • Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder

    Stampas A, Korupolu R, Zhu L, Smith CP, Gustafson K. Safety, Feasibility, and Efficacy of Transcutaneous Tibial Nerve Stimulation in Acute Spinal Cord Injury Neurogenic Bladder: A Randomized Control Pilot Trial. Neuromodulation. Oct 3 2018.

    https://www.ncbi.nlm.nih.gov/pubmed/30284350

  • Pediatric Acute Kidney Injury

    Roy JP, Forster CS. Clinical Progress Note: Pediatric Acute Kidney Injury. Journal of Hospital Medicine. E pub Aug 16, 2019. PMID: 31433778.

    https://www.journalofhospitalmedicine.com/jhospmed/article/206281/hospital-medicine/clinical-progress-note-pediatric-acute-kidney-injury

  • Association of Systemic Antimicrobials with the Expression of Beta-Lacatamases in Bacteria Cultured from Urological Patients

    Forster CS, Powell EA, Deburger B, Courter J, Haslam DB, and Mortensen JE. Association of Systemic Antimicrobials with the Expression of Beta-Lacatamases in Bacteria Cultured from Urological Patients. Diagnostic Microbiology and Infectious Disease, 2019, 94(4): 391-394. PMID: 30890298

    https://www.ncbi.nlm.nih.gov/pubmed/30890298

  • Identification of Urinary CD44 and Prosaposin as Specific Biomarkers of Urinary Tract Infections in Children with Neurogenic Bladders

    Forster CS, Haffey WD, Bennett M, Greis KD, and Devarajan P. Identification of Urinary CD44 and Prosaposin as Specific Biomarkers of Urinary Tract Infections in Children with Neurogenic Bladders. Biomarker Insights, 2019 Mar 15;1. PMID: 30906192

    https://www.ncbi.nlm.nih.gov/pubmed/30906192

  • The Association Between Urodynamic Parameters and Urine NGAL Concentrations in Children with Neurogenic Bladders

    Forster CS, Goldstein S, Pohl H, and Jackson E. The Association Between Urodynamic Parameters and Urine NGAL Concentrations in Children with Neurogenic Bladders. Journal of Pediatric Urology, Epub 2019; Jan 23. PMID: 30799170

    https://www.ncbi.nlm.nih.gov/pubmed/30799170

  • Variation in the Diagnosis of Urinary Tract Infection in Children with Neurogenic Bladders between Subspecialists

    Forster CS, Jackson E, and Goldstein S. Variation in the Diagnosis of Urinary Tract Infection in Children with Neurogenic Bladders between Subspecialists. Journal of Pediatric Urology, 2018 Dec;14(6):567.e1-567.e6. PMID: 30177384

    https://www.ncbi.nlm.nih.gov/pubmed/30177384

  • Identification of Burkholderia fungorum in the urine of an individual with spinal cord injury and augmentation cystoplasty using 16s sequencing

    Nally E, Groah SL, Perez-Losada M, Caldovic L, Ljungberg IH, Sprague B, Castro-Nallar E, Chandal N, Hsieh M, Pohl H. Identification of Burkholderia fungorum in the urine of an individual with spinal cord injury and augmentation cystoplasty using 16s sequencing: Co-pathogen or innocent bystander? Spinal Cord Series Cases 2018 Sep 21;4:85. Doi: 10.1038/s41394-018-0115-2.

    https://www.ncbi.nlm.nih.gov/pubmed/30275977

  • Predictive Ability of NGAL in Identifying Urinary Tract Infection in Children with Neurogenic Bladders

    Forster CS, Elizabeth Jackson, Qing Ma, Michael Bennett, Samir Shah, and Stuart Goldstein. Predictive Ability of NGAL in Identifying Urinary Tract Infection in Children with Neurogenic Bladders. Pediatric Nephrology, 2018; 33(8): 1365-1374. PMID: 29532235

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6218164/

  • Uropathogens and Pyuria in Children with Neurogenic Bladders

    Forster CS, Shaikh N, Hoberman A, Jackson E. Uropathogens and Pyuria in Children with Neurogenic Bladders. Pediatrics, 2018;142(2). PMID: 29618582

    https://www.ncbi.nlm.nih.gov/pubmed/29618582

  • Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC)

    Tractenberg RE, Groah SL, Rounds MK, Ljungberg IH, Schladen MM. Preliminary validation of a Urinary Symptom Questionnaire for individuals with Neuropathic Bladder using Intermittent Catheterization (USQNB-IC): A patient-centered patient reported outcome. PLoS ONE 2018;13(7):e0197568.

    https://www.ncbi.nlm.nih.gov/pubmed/29990375

  • Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitation-acquired urinary tract infections

    Stampas A, Dominick E, Zhu L. Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitation-acquired urinary tract infections: A retrospective study. J Spinal Cord Med 3:1-14. Apr 2018

    https://www.ncbi.nlm.nih.gov/pubmed/29611464

  • The role of the genitourinary microbiome in pediatric urology.

    Gerber DC, Forster CS, Hsieh M. The role of the genitourinary microbiome in pediatric urology: a review. Current Urology Reports. 2018 Feb 22;19(1):13. PMID: 29468401

    https://www.ncbi.nlm.nih.gov/pubmed/29468401

  • Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes

    Tractenberg RE, Garver A, Ljungberg IH, Schladen MM, Groah SL Maintaining primacy of the patient perspective in the development of patient-centered patient reported outcomes.
    PLoS ONE 2017;12(3): e0171114.
    doi:10.1371/journal.pone.0171114

    https://www.ncbi.nlm.nih.gov/pubmed/28257414

  • Does NGAL Reduce Cost?

    Parikh A, Rizzo J, Chalfin D, Canetta P, Forster CS, Sise M, Marroug O, Singer E, Elger A, Elitok S, Schmidt-Ott K, Barasch J, Nickolas T. Does NGAL Reduce Cost? A Cost Analysis of Urine NGAL and Serum Creatinine for Acute Kidney Injury. PLOS One, 2017 September; 12(9). PMID:28953968

    https://www.ncbi.nlm.nih.gov/pubmed/28542336

  • Utility of a Routine Urinalysis in Children Who Require on Clean Intermittent Catheterization

    Forster CS, Haslam DB, Jackson E, Goldstein S. Utility of a Routine Urinalysis in Children Who Require on Clean Intermittent Catheterization. Journal of Pediatric Urology, 2017 October;13(5): 488.e1-488.e5. PMID 28284733

    https://www.ncbi.nlm.nih.gov/pubmed/28284733

  • Urinary NGAL Deficiency in Recurrent Urinary Tract Infections

    Forster CS, Johnson K, Patel V, Rodig N, Barasch J, Bachur R, Lee R. Urinary NGAL Deficiency in Recurrent Urinary Tract Infections. Pediatric Nephrology, 2017 June; 32(6): 1077-80. PMID 28210838

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417074/

  • Unique Transcriptional Programs Identify Subtypes of “Acute Kidney Injury”

    Xu K, Rosenthal P, Paragas N, Hinze C, Gao X, Merth M, Forster CS, Deng R, Bruck E, Boles RW, Tornato A, Jones M, Konig J, Gopal T, D’Agati V, Erdjument-Bromage H, Saggi S, Wagener G, Schmidt-Ott K, Tattonetti N, Tempst P, Oliver J, Guarnieri P, Barasch J. Unique Transcriptional Programs Identify Subtypes of “Acute Kidney Injury”. Journal of the American Society of Nephrology, 2017 June; 28(6): 1729-40. PMID: 28028135

    https://jasn.asnjournals.org/content/28/6/1729

  • Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent Catheterization

    Forster CS, Courter J, Jackson E, Mortensen J, Haslam D. Frequency of Multidrug-Resistant Organisms Cultured From Urine of Children Undergoing Clean Intermittent Catheterization. Journal of the Pediatric Infectious Disease Society, 2017 Nov 24;6(4):332-338. PMID: 29186590

    https://www.ncbi.nlm.nih.gov/pubmed/29186590

  • Redefining healthy urine

    J Urol 2016;196(2):Groah SL, Perez-Losada M, Caldovic L, Ljungberg IH, Sprague B, Castro-Nallar E, Chandal N, Hsieh M, Pohl H. Redefining healthy urine: a cross-sectional exploratory metagenomic study of people with and without bladder dysfunction. J Urol 2016;196(2):579-87..

    https://www.ncbi.nlm.nih.gov/pubmed/26807926

  • Right Test, Wrong Patient

    Forster CS, Herbst L, Jerardi KE, Brady P. Right Test, Wrong Patient: Biomarkers and Value. Hospital Pediatrics, 2016 May; 6(5):315-7. PMID 27052032.

    https://www.ncbi.nlm.nih.gov/pubmed/27052032

Meet our team

Suzanne Groah, MD, MSPH

Dr. Groah is the Project Director for the RRTC, Principal Investigator for research project 1, Co-Principal Investigator for research project 2, and Co-Principal Investigator for research project 3.

Dr. Groah the Director of the Paralysis Rehabilitation and Recovery Program (inpatient, outpatient, and day program) and the Director of Spinal Cord Injury Research at MedStar National Rehabilitation Hospital, as well as Professor of Rehabilitation Medicine at Georgetown University. Currently, Dr. Groah is the Principal Investigator of several investigator-initiated projects on urinary symptoms in individuals with SCI, multiple sclerosis, and spina bifida.

Vanessa Bernal

Vanessa Bernal, BS

Ms. Bernal is the study coordinator for research project 2 at TIRR Memorial Hermann.

Vanessa is a senior research assistant in the UTHealth at Houston Department of PM&R for the past 10 years. She has assisted Dr. Stampas in all aspects of the pilot trials, including consenting subjects, randomization and allocation of treatment, performing and educating on the use of TTNS.

Barbara Bregman

Barbara Bregman, PhD

Dr. Bregman is the Co-Project Director of the RRTC and Director of Training.

Dr. Bregman is Director of Education and Training for the MedStar NRH Research Division, and Professor of Neuroscience and Rehabilitation Medicine at Georgetown University (GU). She is currently Co-Program Director of the NIH K12 Neurorehabilitation and Restorative Neuroscience Training Network, which targets the development of junior faculty in neurorehabilitation. As Chair of the Department of Neuroscience at Georgetown University, faculty development and mentorship were key components of her activities.

Carter Denny

Carter Denny, MD, MPH

Dr. Denny is an early career physician scientist and a Co-Principal Investigator for research project 2.

Dr. Denny has a research interests in systems of care delivery and secondary stroke prevention. Dr. Denny has participated in several stroke clinical trials. With the support of a MHRI New Investigator grant, Dr. Denny is now recruiting hypertensive stroke survivors into a home blood pressure self-management study that she designed with the critical appraisal of the MedStar Research Scholars Program. She was awarded an NIH StrokeNet fellowship as a Georgetown junior faculty member for the 2017-2018 academic year.

Catherine Forester

Catherine Forster, MD

Dr. Forster is an early career physician scientist and Site-PI at CNMC for research project 1.

Dr. Forster is a pediatric hospitalist at Children’s Hospital of Pittsburgh and an Assistant Professor of Pediatrics at University of Pittsburgh. Her research focuses on identifying improved ways to diagnose urinary tract infections in people with NLUTD. She has expertise in the analysis and interpretation of urine biomarkers, including neutrophil gelatinase-associated lipocalin (NGAL), one of the proteins that will be measured in this study. For this project, Dr. Forster will be responsible for processing and analyzing the urine samples provided by participants in one of the research studies.

Margot Giannetti

Margot Giannetti, BA

Ms. Giannetti is the study coordinator for research project 1.

Margot has a long history as a Clinical Research Coordinator at MedStar NRH. Through her experience in coordinating multiple stroke, cerebral palsy and spinal cord injury studies, she has gained invaluable experience in study coordination and also working with people with multiple types of physical disability.

Sashwati Geed

Shashwati Geed, PT, PhD

Dr. Geed is the Biostatistician on research project 1 and research project 3.

Dr. Geed is an Assistant Professor in the Department of Rehabilitation Medicine at the Georgetown University. Her research focuses on both rehabilitation outcomes and the neurophysiology of motor function recovery after stroke. Dr. Geed has particular expertise in longitudinal models to measure recovery, clinical trial design in the context of neurorehab, and refining assessments that measure neurorehabilitation outcomes.

Inger Ljungberg

Inger Ljungberg, MPH

Ms. Ljungberg is a research program manager at MedStar NRH where she has a long history of both coordinating research studies and serving as the project manager on Dr. Groah's ongoing research projects. Through her work she has gained invaluable experience in the ability to monitor timely progression of multiple concurrent studies, facilitate cross team communication, and supervision of budget expenditures.

Amanda Rounds

Amanda Rounds, PhD

Dr. Rounds is an early career scientist, Co- Principal Investigator for research project 3 and Clinical Research Coordinator for project 2.

Dr. Rounds is a Rehabilitation Scientist focusing on research with a multidisciplinary and patient-centered approach. This research will enhance clinical decision making while simultaneously considering the patients quality of life/experience. Therefore, exploring how to improve outcomes of those who have experienced neurological trauma or disease.

Argy Stampas

Argy Stampas, MD

Dr. Stampas is an early career physician researcher and Site-Principal Investigator at TIRR for research project 2.

As a physician researcher, I want to advance the field of rehabilitation using electric stimulation to prevent problems commonly found in spinal cord injury (SCI), including neurogenic bladder and bowel, autonomic dysreflexia, neuropathic pain, and spasticity. In my position as the SCI Medicine Research Director, I can pursue research interests with the support of TIRR Memorial Hermann, UT Health Science Center at Houston, and their research infrastructure to support high-level clinical research. I am involved in the care of hundreds of SCI patients annually, and the institution serves one of the largest SCI populations in the country.

Contact us