One of the newest faculty members with the University of Houston Cullen College of Engineering has won a major grant to help develop new diagnostic tools for female incontinence by using his patient-specific modeling and non-invasive electrical source imaging techniques.
Yingchun Zhang, an assistant professor of biomedical engineering who joined the college last fall, received a three-year grant worth nearly $690,000 from the National Institutes of Health to study the condition. He won the funding through the Pathway to Independence program, which is designed to help young investigators launch long-term successful research careers and is considered one of the most prestigious funding vehicles at the NIH.
Much of this work is centered on a computational model of the pelvic area Zhang has developed. This is perhaps one of the most comprehensive models of its kind, Zhang said. It factors in the size, shape and weight of several internal organs as well as the “pelvic floor,” the collection of muscles and ligaments that provides foundational support for these organs.
Often incontinence is caused by weakness in the pelvic floor. When a person’s pelvic muscles contract, such as when they cough or sneeze, the pelvic floor should continue to strongly supporting the internal organs. But weak support from the pelvic floor causes the organs to shift downward, leading to incontinence.
With this model, Zhang plans to conduct a large number of computer simulations of the pelvic area. By changing different parameters, he should be able to determine exactly which muscles and ligaments can lead to incontinence when weakened.
“Which piece of muscle or ligament plays a key role in pelvic floor support function is still controversial. Maybe there’s a problem with one specific muscle group that is the cause,” he said.
Additional work, he said, will allow him to develop a diagnostic system for female incontinence related to the pelvic floor. By entering a patient’s specific parameters (such as bladder size, internal pressure when coughing, etc.) into a pelvic area model, this tool should allow physicians to determine exactly which parts of the pelvic floor are causing the problem.
This in turn should lead to better interventions. One common treatment for such incontinence involves providing additional support to the pelvic floor through a surgically inserted mesh or sling device.
While this is effective, said Zhang, “we want to do a better job. Eventually, when a patient comes in, we want to perform some diagnostic tests, enter her parameters into a model and find out exactly where that mesh should be inserted and attached.”
Zhang’s work extends beyond the pelvic floor, though. Incontinence also occurs when pressure inside the bladder exceeds the pressure that keeps the urethra closed. There is much about urethra closing pressure that is unknown, however. “We want to find this out,” he said.
Zhang, then, is developing a probe that measures this pressure using electromyography, which measures the electrical activity of muscles. With this data, he should be able to determine which muscles contribute to urethra closing pressure in a healthy individual.
What’s more, physicians using the probe in a clinical setting will be able to determine the exact muscles that aren’t providing their expected closing pressure and thereby are causing incontince.
With this information, Zhang said, doctors should be able to determine the best intervention, ranging from simple nerve stimulation to more involved surgical procedures.
“Incontinence is a problem that is quite common in females, especially older females,” Zhang said. “This research can help us understand its exact causes and develop better interventions. It should end up having a positive impact on many people’s lives.”