ASSESSING MULTIFACTORIAL ETIOLOGY OF OVERACTIVE BLADDER USING A NOVEL PFM-HIP-TRUNK MUSCLE NETWORK ANALYSIS

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Abstract Overactive bladder syndrome (OAB), defined as the presence of urinary urgency with or without urgency urinary incontinence, is a debilitating condition that affects an estimated 15.1% of women in the US alone. OAB is widely treated with pelvic floor muscle (PFM) training, by reducing contractions of the detrusor muscle of the bladder. The PFM, hip, and trunk muscles are synergistic in nature and may be an important, yet overlooked mechanistic factor in OAB. The complicated pelvic anatomy has historically prohibited sophisticated applications of surface EMG technology to the PFM, and the intermuscular network between the PFM and hip/trunk muscles. Currently, clinical classification of PFM function is based on a clinician’s qualitative assessment using vaginal palpation via digital examination. Additionally, quantitative assessment of hip/trunk muscle abnormalities potentially associated with PFM dysfunction are not standard. Designing an objective measure of PFM activation and PFM-to-Hip/Trunk intermuscular connectivity is imperative to advance the diagnostic capabilities for OAB. Such advancement can help better understand the musculoskeletal impairments inherently associated with OAB, and further lead to the development of a PFM-Hip/Trunk phenotyping framework which would allow patients with OAB to be categorized to facilitate individualized treatment. Unfortunately, no technology is currently available for quantitatively and objectively assessing comprehensive PFM-Hip/Trunk etiologic factors associated with OAB, which, otherwise, would advance the understanding of the underlying mechanisms and allow for the phenotyping of OAB subtypes for appropriate intervention selection. Our team has successfully 1) developed a novel intra-vaginal high-density surface electromyography (HD-sEMG) technique to reliably and quantitatively assess PFM overactivity; 2) developed a novel muscle network analysis technique to reveal, for the first time, the inter-muscular connectivity pattern alterations among patients with neuromuscular conditions; and 3) demonstrated the feasibility to cluster OAB into phenotypic subgroups, depending on the underlying mechanism. By taking advantage of the advancements in intra-vaginal HD-sEMG sensing and muscle network analysis, this study aims to assess mechanistic fundamentals of neuromuscular features of the comprehensive PFM-Hip-Trunk muscle network. This research represents the first effort to comprehensively assess pelvic floor, hip and trunk muscle activity alterations, PFM-to-Hip/Trunk inter-muscular connectivity, and distinct PFM phenotypic subtypes in OAB. The integration of these multifactorial assessments will advance our understanding of the multifactorial pathology of OAB, particularly OAB-dry patients (urinary urgency without urgency urinary incontinence) which is poorly understood and characterized in the literature. The quantification of relative importance of these pathological contributors will allow for phenotyping OAB-dry subtypes, thus resulting in novel personalized treatments.