Transfer Learning for Effective Urolithiasis Detection / 대한배뇨장애요실금학회지

Purpose@#Urolithiasis is a common disease that can cause acute pain and complications. The objective of this study was to develop a deep learning model utilizing transfer learning for the rapid and accurate detection of urinary tract stones. By employing this method, we aim to improve the efficiency of medical staff and contribute to the progress of deep learning-based medical image diagnostic technology. @*Methods@#The ResNet50 model was employed to develop feature extractors for detecting urinary tract stones. Transfer learning was applied by utilizing the weights of pretrained models as initial values, and the models were fine-tuned with the provided data. The model’s performance was evaluated using accuracy, precision-recall, and receiver operating characteristic curve metrics. @*Results@#The ResNet-50-based deep learning model demonstrated high accuracy and sensitivity, outperforming traditional methods. Specifically, it enabled a rapid diagnosis of the presence or absence of urinary tract stones, thereby assisting doctors in their decision-making process. @*Conclusions@#This research makes a meaningful contribution by accelerating the clinical implementation of urinary tract stone detection technology utilizing ResNet-50. The deep learning model can swiftly identify the presence or absence of urinary tract stones, thereby enhancing the efficiency of medical staff. We expect that this study will contribute to the advancement of medical imaging diagnostic technology based on deep learning.

Improving Foley Catheter Insertion Procedure by Developing Foley Introducer: A 100-Year Overdue Innovation / 대한배뇨장애요실금학회지

Purpose@#Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020’s, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients’ discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility. @*Methods@#We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains. @*Results@#As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time. @*Conclusions@#We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device.

Development of an Artificial Intelligence-Based Support Technology for Urethral and Ureteral Stricture Surgery / 대한배뇨장애요실금학회지

Purpose@#This paper proposes a technological system that uses artificial intelligence to recognize and guide the operator to the exact stenosis area during endoscopic surgery in patients with urethral or ureteral strictures. The aim of this technological solution was to increase surgical efficiency. @*Methods@#The proposed system utilizes the ResNet-50 algorithm, an artificial intelligence technology, and analyzes images entering the endoscope during surgery to detect the stenosis location accurately and provide intraoperative clinical assistance. The ResNet-50 algorithm was chosen to facilitate accurate detection of the stenosis site. @*Results@#The high recognition accuracy of the system was confirmed by an average final sensitivity value of 0.96. Since sensitivity is a measure of the probability of a true-positive test, this finding confirms that the system provided accurate guidance to the stenosis area when used for support in actual surgery. @*Conclusions@#The proposed method supports surgery for patients with urethral or ureteral strictures by applying the ResNet-50 algorithm. The system analyzes images entering the endoscope during surgery and accurately detects stenosis, thereby assisting in surgery. In future research, we intend to provide both conservative and flexible boundaries of the strictures.

Personalized Urination Activity Management Based on an Intelligent System Using a Wearable Device / 대한배뇨장애요실금학회지

Purpose@#In this study, a urinary management system was established to collect and analyze urinary time and interval data detected through patient-worn smart bands, and the results of the analysis were shown through a web-based visualization to enable monitoring and appropriate feedback for urological patients. @*Methods@#We designed a device that can recognize urination time and spacing based on patient-specific posture and consistent posture changes, and we built a urination patient management system based on this device. The order of body movements during urination was consistent in terms of time characteristics; therefore, sequential data were analyzed and urinary activity was recognized using repeated neural networks and long-term short-term memory systems. The results were implemented as a web (HTML5) service program, enabling visual support for clinical diagnostic assistance. @*Results@#Experiments were conducted to evaluate the performance of the proposed recognition techniques. The effectiveness of smart band monitoring urination was evaluated in 30 men (average age, 28.73 years; range, 26–34 years) without urination problems. The entire experiment lasted a total of 3 days. The final accuracy of the algorithm was calculated based on urological clinical guidelines. This experiment showed a high average accuracy of 95.8%, demonstrating the soundness of the proposed algorithm. @*Conclusions@#This urinary activity management system showed high accuracy and was applied in a clinical environment to characterize patients’ urinary patterns. As wearable devices are developed and generalized, algorithms capable of detecting certain sequential body motor patterns that reflect certain physiological behaviors can be a new methodology for studying human physiological behaviors. It is also thought that these systems will have a significant impact on diagnostic assistance for clinicians.

Irreversible Bladder Remodeling Induced by Fibrosis / 대한배뇨장애요실금학회지

Underactive bladder and impaired bladder compliance are irreversible problems associated with bladder fibrosis. Remodeling of the extracellular matrix is regarded as an important mechanism associated with bladder fibrosis. However, various risk factors and conditions contribute to the functional impairment of the bladder associated with fibrosis, and there is limited knowledge about bladder fibrosis-associated problems in the field of neurourology. Further studies are thus necessary to elucidate the underlying mechanism of bladder fibrosis and to identify effective treatment.

Personalized Urination Activity Management Based on an Intelligent System Using a Wearable Device / 대한배뇨장애요실금학회지

Purpose@#In this study, a urinary management system was established to collect and analyze urinary time and interval data detected through patient-worn smart bands, and the results of the analysis were shown through a web-based visualization to enable monitoring and appropriate feedback for urological patients. @*Methods@#We designed a device that can recognize urination time and spacing based on patient-specific posture and consistent posture changes, and we built a urination patient management system based on this device. The order of body movements during urination was consistent in terms of time characteristics; therefore, sequential data were analyzed and urinary activity was recognized using repeated neural networks and long-term short-term memory systems. The results were implemented as a web (HTML5) service program, enabling visual support for clinical diagnostic assistance. @*Results@#Experiments were conducted to evaluate the performance of the proposed recognition techniques. The effectiveness of smart band monitoring urination was evaluated in 30 men (average age, 28.73 years; range, 26–34 years) without urination problems. The entire experiment lasted a total of 3 days. The final accuracy of the algorithm was calculated based on urological clinical guidelines. This experiment showed a high average accuracy of 95.8%, demonstrating the soundness of the proposed algorithm. @*Conclusions@#This urinary activity management system showed high accuracy and was applied in a clinical environment to characterize patients’ urinary patterns. As wearable devices are developed and generalized, algorithms capable of detecting certain sequential body motor patterns that reflect certain physiological behaviors can be a new methodology for studying human physiological behaviors. It is also thought that these systems will have a significant impact on diagnostic assistance for clinicians.

Irreversible Bladder Remodeling Induced by Fibrosis / 대한배뇨장애요실금학회지

Underactive bladder and impaired bladder compliance are irreversible problems associated with bladder fibrosis. Remodeling of the extracellular matrix is regarded as an important mechanism associated with bladder fibrosis. However, various risk factors and conditions contribute to the functional impairment of the bladder associated with fibrosis, and there is limited knowledge about bladder fibrosis-associated problems in the field of neurourology. Further studies are thus necessary to elucidate the underlying mechanism of bladder fibrosis and to identify effective treatment.

Past, Present, and Future in the Study of Neural Control of the Lower Urinary Tract / 대한배뇨장애요실금학회지

The neurological coordination of the lower urinary tract can be analyzed from the perspective of motor neurons or sensory neurons. First, sensory nerves with receptors in the bladder and urethra transmits stimuli to the cerebral cortex through the periaqueductal gray (PAG) of the midbrain. Upon the recognition of stimuli, the cerebrum carries out decision-making in response. Motor neurons are divided into upper motor neurons (UMNs) and lower motor neurons (LMNs) and UMNs coordinate storage and urination in the brainstem for synergic voiding. In contrast, LMNs, which originate in the spinal cord, cause muscles to contract. These neurons are present in the sacrum, and in particular, a specific neuron group called Onuf’s nucleus is responsible for the contraction of the external urethral sphincter and maintains continence in states of rising vesical pressure through voluntary contraction of the sphincter. Parasympathetic neurons originating from S2–S4 are responsible for the contraction of bladder muscles, while sympathetic neurons are responsible for contraction of the urethral smooth muscle, including the bladder neck, during the guarding reflex. UMNs are controlled in the pons where various motor stimuli to the LMNs are directed along with control to various other pelvic organs, and in the PAG, where complex signals from the brain are received and integrated. Future understanding of the complex mechanisms of micturition requires integrative knowledge from various fields encompassing these distinct disciplines.

Stem Cell Therapy for Neurogenic Bladder After Spinal Cord Injury: Clinically Possible? / 대한배뇨장애요실금학회지

Neurogenic bladder (NB) after spinal cord injury (SCI) is a common complication that inhibits normal daily activities and reduces the quality of life. Regrettably, the current therapeutic methods for NB are inadequate. Therefore, numerous studies have been conducted to develop new treatments for NB associated with SCI. Moreover, a myriad of preclinical and clinical trials on the effects and safety of stem cell therapy in patients with SCI have been performed, and several studies have demonstrated improvements in urodynamic parameters, as well as in sensory and motor function, after stem cell therapy. These results are promising; however, further high-quality clinical studies are necessary to compensate for a lack of randomized trials, the modest number of participants, variation in the types of stem cells used, and inconsistency in routes of administration.

Evaluation of PTEN Inhibitor Following Spinal Cord Injury on Recovery of Voiding Efficiency and Motor Function Observed by Regeneration in Spinal Cord / 대한배뇨장애요실금학회지

Purpose@#Neurogenic bladder (NB) associated with spinal cord injury (SCI) is a serious health problem. However, no effective treatment has been developed for SCI patients with NB. Phosphatase and tensin homolog deleted on chromosome 10 (PTEN) inhibitors have been proposed as a promising option for inducing neural regeneration. Therefore, we investigated the effects of a tissue gene nerve (TGN), PTEN inhibitor, on voiding function, motor function, and the expression of growth factors after SCI. @*Methods@#In this experiment, female rats were randomly divided into 3 groups (n=10 in each group): the sham-operation group, the SCI-induced group, and the SCI-induced and TGN-treated group. Cystometry; the Basso, Beattie, and Bresnahan (BBB) scale test; the ladder walking test; hematoxylin and eosin staining; and Western blotting for brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and nerve growth factor (NGF) were performed to evaluate functional and molecular changes. @*Results@#After SCI, the rats exhibited decreased walking ability according to the BBB scale test and impaired coordinative function according to the ladder walking test. The PTEN inhibitor promoted enhanced walking ability and coordinative function. Cystometry showed voiding impairment after SCI and improved voiding function was observed after PTEN treatment. Overexpression of VEGF, BDNF, and NGF were observed after SCI. Administration of PTEN inhibitors significantly attenuated the overexpression of growth factors due to SCI. @*Conclusion@#PTEN inhibitor treatment diminished the overexpression of growth factors and promoted the repair of damaged tissue. PTEN inhibitor-treated rats also showed improved motor function and improved voiding function. Therefore, we suggest TGN as a new therapeutic agent that can be applied after SCI.

The Prospect of a New Smart Healthcare System: A Wearable Device-Based Complex Structure of Position Detecting and Location Recognition System / 대한배뇨장애요실금학회지

In upcoming fourth industrial revolution era, it is inevitable to address smart healthcare as not only scientist but also clinician. We have the task to plan and realize this through human imagination, creativity, and applicability for the clarification of the direction of the development and utilization of this technology. One thing that is clear is that it is important to understand what information is needed, how to interpret it, what will be the outcomes, and how to respond in artificial intelligence and Internet of Things era. Therefore, we would like to briefly discuss the characteristics of smart healthcare, and, suggest one approach that is easily applicable in the current situation.

Long-term Surgical and Chemical Castration Deteriorates Memory Function Through Downregulation of PKA/CREB/BDNF and c-Raf/MEK/ERK Pathways in Hippocampus / 대한배뇨장애요실금학회지

PURPOSE: Goserelin is a drug used for chemical castration. In a rat model, we investigated whether surgical and chemical castration affected memory ability through the protein kinase A (PKA)/cyclic adenosine monophosphate response element-binding protein (CREB)/brain-derived neurotrophic factor (BDNF) and c-Raf/mitogen-activated protein kinases-extracellular signal–regulated kinases (MEK)/extracellular signal–regulated kinases (ERK) pathways in the hippocampus. METHODS: Orchiectomy was performed for surgical castration and goserelin acetate was subcutaneously transplanted into the anterior abdominal wall for chemical castration. Immunohistochemistry was done to quantify neurogenesis. To assess the involvement of the PKA/CREB/BDNF and c-Raf/MEK/ERK pathways in the memory process, western blots were used. RESULTS: The orchiectomy group and the goserelin group showed less neurogenesis and impaired short-term and spatial memory. Phosphorylation of PKA/CREB/BDNF and phosphorylation of c-Raf/MEK/ERK decreased in the orchiectomy and goserelin groups. CONCLUSIONS: Short-term memory and spatial memory were affected by surgical and chemical castration via the PKA/CREB/BDNF and c-Raf/MEK/ERK signaling pathways.

At the End of the Year 2019 / 대한배뇨장애요실금학회지

No abstract available.

Influence of Circadian Disruption Associated With Artificial Light at Night on Micturition Patterns in Shift Workers / 대한배뇨장애요실금학회지

Shift workers often experience problems associated with circadian disruption associated with artificial light at night and nocturia is commonly noted in night-shift workers. Nocturia associated with circadian disruption is due to increased urine production of the kidney and decreased storage function of the bladder. A recent discovery of peripheral clock genes in the bladder and their role in contractile property of the bladder support that micturition is closely related to the circadian rhythm. Moreover, there are clinical studies showed that shift workers more often experienced nocturia due to circadian disruption. However, comparing with other health problems, concerns on nocturia and voiding dysfunction associated with circadian disruption are insufficient. Therefore, further studies about voiding dysfunction associated with the circadian disruption in shift workers are necessary.

Treadmill Exercise Alleviates Circadian Rhythm Disruption-Induced Memory Deficits by Activation of Glucocorticoid Receptor and Brain-Derived Neurotrophic Factor-Dependent Pathway / 대한배뇨장애요실금학회지

PURPOSE@#Circadian rhythm affects learning process, memory consolidation, and long-term memory. In this study, the alleviating effect of exercise on circadian rhythm disruption-induced memory deficits was investigated.@*METHODS@#BMAL1 knockdown transgenic mice (BMAL1 TG) were used as the BMAL1-TG group and the BMAL1-TG with treadmill exercise group. Female C57BL/6J mice of the same age were used as the wildtype group and the wildtype with treadmill exercise group. The mice in the treadmill exercise groups performed running on a motorized treadmill under the dark-dark conditions for 8 weeks. Short-term memory, nonspatial object memory, and spatial learning memory were determined using stepdown avoidance test, novel object-recognition test, and radial 8-arm maze test. Immunohistochemistry for doublecortin and 5-bromo-2’-deoxyuridine was conducted for the determination of hippocampal neurogenesis. Using the western blot analysis, we determined the expressions of glucocorticoid receptor (GR) and factors related to the neurogenesis and memory consolidation, such as brain-derived neurotrophic factor, tyrosine kinase B, p44/42 mitogen-activated protein kinase, cyclic AMP-responsive element binding protein, phosphatidylinositol 3-kinase, protein kinas B, protein kinase C alpha, early-growth-response gene 1.@*RESULTS@#Circadian rhythm disruption impaired memory function through inhibiting the expressions of GR and the factors related to neurogenesis and memory consolidation. Treadmill exercise improved memory function via enhancing the expressions of GR and above-mentioned factors.@*CONCLUSIONS@#Treadmill exercise acts as the zeitgeber that improves memory function under the circadian rhythm disrupted conditions.

On Impact Factor / 대한배뇨장애요실금학회지

No abstract available.

Treadmill Exercise Improves Motor Function by Suppressing Purkinje Cell Loss in Parkinson Disease Rats / 대한배뇨장애요실금학회지

PURPOSE: Rotenone is the most widely used neurotoxin for the making Parkinson disease (PD) animal model. The neurodegenerative disorder PD shows symptoms, such as slowness of movements, tremor at resting, rigidity, disturbance of gait, and instability of posture. We investigated whether treadmill running improves motor ability using rotenone-caused PD rats. The effect of treadmill running on PD was also assessed in relation with apoptosis of cerebellar Purkinje cells. METHODS: Treadmill running was applied to the rats in the exercise groups for 30 minutes once a day for 4 weeks, starting 4 weeks after birth. We used rota-rod test for the determination of motor coordination and balance. In this experiment, terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining, immunohistochemistry for calbindin, glial fibrillary acidic protein (GFAP), Iba-1, and western blot analysis for Bax and Bcl-2 were performed. RESULTS: Treadmill running enhanced motor balance and coordination by preventing the loss of Purkinje cells in the cerebellar vermis. Treadmill running suppressed PD-induced expression of GFAP-positive reactive astrocytes and Iba-1-positive microglia, showing that treadmill running suppressed reactive astrogliosis and microglia activation. Treadmill running suppressed TUNEL-positive cell number and Bax expression and enhanced Bcl-2 expression, demonstrating that treadmill running inhibited the progress of apoptosis in the cerebellum of rotenone-induced PD rats. CONCLUSIONS: Treadmill running improved motor ability of the rotenone-induced PD rats by inhibiting apoptosis in the cerebellum. Apoptosis suppressing effect of treadmill running on rotenone-induced PD was achieved via suppression of reactive astrocyte and inhibition of microglial activation.

Personalized Urination Activity Recognition Based on a Recurrent Neural Network Using Smart Band / 대한배뇨장애요실금학회지

PURPOSE: Though it is very important obtaining exact data about patients’ voiding patterns for managing voiding dysfunction, actual practice is very difficult and cumbersome. In this study, data about urination time and interval measured by smart band device on patients’ wrist were collected and analyzed to resolve the clinical arguments about the efficacy of voiding diary. By developing a smart band based algorithm for recognition of complex and serial pattern of motion, this study aimed to explore the feasibility of measurement the urination time and intervals for voiding dysfunction management. METHODS: We designed a device capable of recognizing urination time and intervals based on specific postures of the patient and consistent changes in posture. These motion data were obtained by a smart band worn on the wrist. An algorithm that recognizes the repetitive and common 3-step behavior for urination (forward movement, urination, backward movement) was devised based on the movement and tilt angle data collected from a 3-axis accelerometer. The sequence of body movements during voiding has consistent temporal characteristics, so we used a recurrent neural network and long short-term memory based framework to analyze the sequential data and to recognize urination time. Real-time data were acquired from the smart band, and for data corresponding to a certain duration, the value of the signals was calculated and then compared with the set analysis model to calculate the time of urination. A comparative study was conducted between real voiding and device-detected voiding to assess the performance of the proposed recognition technology. RESULTS: The accuracy of the algorithm was calculated based on clinical guidelines established by urologists. The accuracy of this detecting device was high (up to 94.2%), proving the robustness of the proposed algorithm. CONCLUSIONS: This urination behavior recognition technology showed high accuracy and could be applied in clinical settings to characterize patients’ voiding patterns. As wearable devices are developed and generalized, algorithms detecting consistent sequential body movement patterns reflecting specific physiologic behavior might be a new methodology for studying human physiologic behavior.

Enucleated Weight/Enucleation Time, Is It Appropriate for Estimating Enucleation Skills for Holmium Laser Enucleation of the Prostate? A Consideration of Energy Consumption

PURPOSE: To date, the parameters for evaluating enucleation efficiency have only considered enucleation time, although operators simultaneously consume both time and energy during holmium laser enucleation of the prostate. This study was undertaken to find a better way of assessing enucleation skills, considering both enucleation time and consumed energy. MATERIALS AND METHODS: One hundred (n=100) consecutive patients who underwent holmium laser enucleation of the prostate from April 2012 to April 2014 by a single surgeon were enrolled. Ten groups of 10 consecutive cases were used to analyze the parameters of enucleation efficiency. RESULTS: The mean enucleation time, consumed energy, and enucleated weight were 41.3±19.2 minutes, 66.2±36.0 kJ, and 26.6±21.8 g, respectively. Concerning learning curves, like enucleation time-efficacy (=enucleated weight/enucleation time), enucleation energy-efficacy (=enucleated weight/consumed energy) also had an increasing tendency. Enucleation ratio efficacy (=enucleated weight/transitional zone volume/enucleation time) plateaued after 30 cases. However, enucleation time-energy-efficacy (=enucleated weight/enucleation time/consumed energy) continued to increase after 30 cases and plateaued at 61 to 70 cases. Furthermore, one-way analysis of variance showed that group means for enucleation time-energy-efficacy (F=3.560, p=0.001) were significantly different, but that those of enucleation ratio efficacy (F=1.931, p=0.057) were not. CONCLUSIONS: When both time and energy were considered, enucleation skills continued to improve even after 30 cases and plateaued at 61 to 70 cases. Therefore, we propose that enucleation time-energy-efficacy should be used as a more appropriate parameter than enucleation ratio efficacy for evaluating enucleation skills.

Afferent Pathway-Mediated Effect of α1 Adrenergic Antagonist, Tamsulosin, on the Neurogenic Bladder After Spinal Cord Injury / 대한배뇨장애요실금학회지

PURPOSE: The functions of the lower urinary tract (LUT), such as voiding and storing urine, are dependent on complex central neural networks located in the brain, spinal cord, and peripheral ganglia. Thus, the functions of the LUT are susceptible to various neurologic disorders including spinal cord injury (SCI). SCI at the cervical or thoracic levels disrupts voluntary control of voiding and the normal reflex pathways coordinating bladder and sphincter functions. In this context, it is noteworthy that α1-adrenoceptor blockers have been reported to relieve voiding symptoms and storage symptoms in elderly men with benign prostatic hyperplasia (BPH). Tamsulosin, an α1-adrenoceptor blocker, is also considered the most effective regimen for patients with LUT symptoms such as BPH and overactive bladder (OAB). METHODS: In the present study, the effects of tamsulosin on the expression of c-Fos, nerve growth factor (NGF), and nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d) in the afferent micturition areas, including the pontine micturition center (PMC), the ventrolateral periaqueductal gray matter (vlPAG), and the spinal cord (L5), of rats with an SCI were investigated. RESULTS: SCI was found to remarkably upregulate the expression of c-Fos, NGF, and NADPH-d in the afferent pathway of micturition, the dorsal horn of L5, the vlPAG, and the PMC, resulting in the symptoms of OAB. In contrast, tamsulosin treatment significantly suppressed these neural activities and the production of nitric oxide in the afferent pathways of micturition, and consequently, attenuated the symptoms of OAB. CONCLUSIONS: Based on these results, tamsulosin, an α1-adrenoceptor antagonist, could be used to attenuate bladder dysfunction following SCI. However, further studies are needed to elucidate the exact mechanism and effects of tamsulosin on the afferent pathways of micturition.