Quantification and Modeling of Bladder Biomechanics Mechanisms Linking Spontaneous Rhythmic Contractions and Dynamic Elasticity to Detrusor Overactivity
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Doctor of Philosophy
Mechanical and Nuclear Engineering
Overactive bladder (OAB) is a chronic condition affecting approximately 20% of adults in the United States. Detrusor overactivity (DO) is the presence of non-voiding contractions in the detrusor (bladder) muscle during filling and is present in some individuals with OAB. DO is currently identified visually during a urodynamics (UD) study involving pressure catheters and filling and voiding of the bladder to evaluate function. UD provides limited subtyping of DO, and an incomplete understanding of mechanisms contributing to OAB.
Aim 1 of this study was to develop objective tools to quantify, subgroup and better understand rhythmic DO. The results indicate that high amplitude rhythmic DO may represent a clinically significant OAB subtype. Aim 2 focused on a biomechanical bladder property, dynamic elasticity (DE), identified during a previous pilot study. DE may contribute to regulation of bladder wall tension and was characterized in a pig bladder model and participants with and without OAB. A conceptual model linking DO and dynamic elasticity was tested.
Novel tools to detect and quantify DO in a more objective fashion were developed and provided evidence that high amplitude rhythmic DO may be clinically significant. DE was characterized clinically and in an isolated pig bladder model. A novel DE index was defined. Testing the conceptual model identified an association between dynamic elasticity and the absence of DO. Quantifying DO and characterizing dynamic elasticity provided important insight the regulation of bladder wall biomechanics and how this regulation may be altered by DO in individuals with OAB.
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