Biomechanics and Electromyography Inassessing Female Stress Urinary Incontinence
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Introduction: Stress urinary incontinence (SUI), the involuntary urinary leakage associated with increases in intra-abdominal pressure, has a prevalence of 25–50% in U.S. women and the number of those who will undergo surgery will increase by half in the next forty years. SUI negatively affects the patient’s quality of life and places a great burden to the society. The functional anatomy of the continence mechanism remains vaguely understood. Hence my dissertation aims at offering a complete description of the pelvic floor muscles (PFM), the key contributor to the continence, thorough biomechanical and neurophysiological approaches. Methods: The biomechanical approach involves the development of a subject-specific finite element (FE) model of the female pelvic floor region. Subsequent computer simulations are targeted at finding the most contributive muscle to the urethral support function and evaluating current treatment strategies using a mini-sling. The neurophysiological approach involves the implementation of a novel surface electromyography (EMG) probe to acquire bioelectrical information of PFMs and the assessment of their innervations in healthy subjects and patients. Results: An FE pelvic floor model was developed which incorporates 40+ anatomical structural in the pelvis, representing the most complete model in the field. Simulation results showed that the vaginal walls, puborectalis, and pubococcygeus are the most important structures and that mid-distal post-urethral implantation represents the optimal location. Innervation zones of PFMs have been successfully identified and described for multiple PFMs. An high-density surface EMG-based motor unit number estimation approach was developed, providing a novel tool to evaluate the condition of neurologically impaired PFM. Conclusions: The combined information greatly advances our understanding of the physiology of PFM and would lay a firm foundation to novel, non-invasive, patient-specific interventional strategies in the future.