University of Houston, Department of Biomedical Engineering, Houston, Texas.
Department of Physical Therapy, Washington University School of Medicine, St. Louis, Missouri.
J Urol. 2020 Dec;204(6):1275-1283. doi: 10.1097/JU.0000000000001237. Epub 2020 Jul 6.
Up to 85% of women with interstitial cystitis/bladder pain syndrome have pelvic floor dysfunction and hypertonicity. Current evaluation methodologies lack objective measures of pelvic floor muscle activity. We examined the ability of using intravaginal high-density surface electromyography to quantitatively, objectively and noninvasively map pelvic floor muscle activity and innervation zone locations in patients with interstitial cystitis/bladder pain syndrome.
Fifteen women with interstitial cystitis/bladder pain syndrome and 15 controls underwent 2 sessions of digital pelvic examinations and high-density surface electromyography assessments. The root mean squared amplitude of high-density surface electromyography was first calculated, and the resting root mean squared ratio was then calculated by normalizing the resting electromyography root mean squared to the peak electromyography amplitude reached during maximum voluntary contraction. Innervation zone distributions were obtained from decomposed high-density surface electromyography signals. The correlation between the root mean squared ratio and interstitial cystitis/bladder pain syndrome symptom scores and pelvic floor muscle alignment were investigated in patients with interstitial cystitis/bladder pain syndrome and healthy controls.
Women with interstitial cystitis/bladder pain syndrome demonstrated significantly increased resting root mean squared ratios compared to controls (0.155±0.048 vs 0.099±0.041, p=0.0019). Significant correlations were found between resting root mean squared ratio and patient reported pain (r=0.523, p=0.003), interstitial cystitis symptom (r=0.521, p=0.003) and problem indices (r=0.60, p <0.001). In addition, women with interstitial cystitis/bladder pain syndrome were more likely to have shortened pelvic floor muscles (80%, 12 vs 13.3%, 2, p <0.01). Women with shortened pelvic floor muscles demonstrated significantly higher resting root mean squared ratio compared to those with normal pelvic floor muscle length (0.155±0.046 vs 0.107±0.040, p=0.0058).
Intravaginal high-density surface electromyography offers an objective and quantitative strategy to noninvasively assess pelvic floor muscle dysfunction in women with interstitial cystitis/bladder pain syndrome. Abundant spatiotemporal muscle activity information captured by high-density surface electromyography allows for mapping innervation zone distributions for major pelvic floor muscles.
多达 85%的间质性膀胱炎/膀胱疼痛综合征女性存在盆底功能障碍和张力过高。目前的评估方法缺乏对盆底肌肉活动的客观测量。我们研究了使用阴道内高密度表面肌电图定量、客观和无创地绘制间质性膀胱炎/膀胱疼痛综合征患者盆底肌肉活动和神经支配区位置的能力。
15 名间质性膀胱炎/膀胱疼痛综合征女性和 15 名对照者接受了 2 次数字骨盆检查和高密度表面肌电图评估。首先计算高密度表面肌电图的均方根幅度，然后通过将静息肌电图均方根归一化为最大随意收缩时达到的肌电图幅度，计算静息均方根比。从分解的高密度表面肌电图信号中获得神经支配区分布。在间质性膀胱炎/膀胱疼痛综合征患者和健康对照组中，研究静息均方根比与间质性膀胱炎/膀胱疼痛综合征症状评分和盆底肌肉排列之间的相关性。
间质性膀胱炎/膀胱疼痛综合征女性的静息均方根比明显高于对照组（0.155±0.048 比 0.099±0.041，p=0.0019）。静息均方根比与患者报告的疼痛（r=0.523，p=0.003）、间质性膀胱炎症状（r=0.521，p=0.003）和问题指数（r=0.60，p<0.001）呈显著相关性。此外，间质性膀胱炎/膀胱疼痛综合征女性更有可能出现盆底肌肉缩短（80%，12 比 13.3%，2，p<0.01）。盆底肌肉缩短的女性静息均方根比明显高于盆底肌肉长度正常的女性（0.155±0.046 比 0.107±0.040，p=0.0058）。
阴道内高密度表面肌电图为评估间质性膀胱炎/膀胱疼痛综合征女性盆底肌肉功能障碍提供了一种客观、定量的无创策略。高密度表面肌电图捕获的丰富的时空肌肉活动信息允许绘制主要盆底肌肉的神经支配区分布。
