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

摘要 膀胱过度活动综合征（OAB），定义为尿急伴或不伴尿急 尿失禁是一种使人衰弱的病症，仅在美国就影响估计15.1%的妇女。 OAB广泛通过骨盆底肌肉（PFM）训练来治疗，通过减少逼尿肌的收缩 膀胱的肌肉PFM、臀部和躯干肌肉在本质上是协同作用的， 但被忽视的机械因素。复杂的骨盆解剖结构在历史上 表面肌电技术在PFM中的复杂应用，以及 PFM和臀部/躯干肌肉。目前，PFM功能的临床分类是基于临床医生的 通过手指检查使用阴道触诊进行定性评估。此外，定量评估 与PFM功能障碍潜在相关的髋/躯干肌肉异常并不标准。设计 客观测量PFM激活和PFM-髋关节/躯干肌间连接是必要的， 提高OAB的诊断能力。这种进步可以帮助更好地理解 与OAB固有相关的肌肉骨骼损伤，并进一步导致 PFM-Hip/Trunk表型分析框架，允许对OAB患者进行分类，以促进 个性化治疗。不幸的是，目前还没有技术可以定量和客观地 评估与OAB相关的综合PFM-髋关节/躯干病因因素，否则， 促进对潜在机制的理解，并允许OAB亚型的表型分型 选择合适的干预措施。 我们的团队已经成功地1）开发了一种新型的阴道内高密度表面肌电图 （HD-sEMG）技术，以可靠和定量评估PFM过度活动; 2）开发了一种新的肌肉 网络分析技术首次揭示了肌肉间连接模式的变化 在神经肌肉疾病患者中;和3）证明了将OAB聚类为 表型亚组，这取决于潜在的机制。通过利用先进的 在阴道内HD-sEMG传感和肌肉网络分析中，本研究旨在评估 综合性股骨-髋-躯干肌肉网络的神经肌肉特征基础。这 这项研究首次全面评估了骨盆底、臀部和躯干肌肉的活动。 OAB中的改变、PFM-髋关节/躯干肌间连接和不同的PFM表型亚型。 这些多因素评估的整合将促进我们对多因素评估的理解。 OAB的病理学，特别是OAB-干性患者（尿急，无急迫性尿失禁） 在文献中对其了解和表征很少。相对重要性的量化 这些病理学贡献者将允许对OAB-干亚型进行表型分型，从而产生新的 个性化治疗。

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.