Transfer Learning for Effective Urolithiasis Detection.

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. CONCLUSION: 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.

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. CONCLUSION: 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.

Artificial Intelligence-Based Patient Monitoring System for Medical Support.

PURPOSE: In this paper, we present the development of a monitoring system designed to aid in the management and prevention of conditions related to urination. The system features an artificial intelligence (AI)-based recognition technology that automatically records a user's urination activity. Additionally, we developed a technology that analyzes movements to prevent neurogenic bladder. METHODS: Our approach included the creation of AI-based recognition technology that automatically logs users' urination activities, as well as the development of technology that analyzes movements to prevent neurogenic bladder. Initially, we employed a recurrent neural network model for the urination activity recognition technology. For predicting the risk of neurogenic bladder, we utilized convolutional neural network (CNN)-based AI technology. RESULTS: The performance of the proposed system was evaluated using a study population of 30 patients with urinary tract dysfunction, who collected data over a 60-day period. The results demonstrated an average accuracy of 94.2% in recognizing urinary tract activity, thereby confirming the effectiveness of the recognition technology. Furthermore, the motion analysis technology for preventing neurogenic bladder, which also employed CNN-based AI, showed promising results with an average accuracy of 83%. CONCLUSION: In this study, we developed a urination disease monitoring system aimed at predicting and managing risks for patients with urination issues. The system is designed to support the entire care cycle of a patient by leveraging AI technology that processes various image and signal data. We anticipate that this system will evolve into digital treatment products, ultimately providing therapeutic benefits to patients.

A Discussion Between Past and Present Editor-in-Chief of the International Neurourology Journal: Three Decades of History.

The International Neurourology Journal (Int Neurourol J, INJ) is a quarterly international journal that publishes high-quality research papers that provide the most significant and promising achievements in the fields of clinical neurourology and fundamental science. Specifically, fundamental science includes the most influential research papers from all fields of science and technology, revolutionizing what physicians and researchers practicing the art of neurourology worldwide know. Thus, we welcome valuable basic research articles to introduce cutting-edge translational research of fundamental sciences to clinical neurourology. In the editorials, urologists will present their perspectives on these articles. The original mission statement of the INJ was published on October 12, 1997. INJ provides authors a fast review of their work and makes a decision in an average of 3 to 4 weeks of receiving submissions. If accepted, articles are posted online in fully citable form. Supplementary issues will be published interim to quarterlies, as necessary, to fully allow berth to accept and publish relevant articles. Science Citation Index Expanded (SCIE, Web of Science), Scopus, PubMed, PubMed Central, KoreaMed, KoMCI, WPRIM, WorldWideScience.org, DOI/Crossref, EBSCO, Google Scholar.

Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months.

There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients' symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient's symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.

A Study on the Optimal Artificial Intelligence Model for Determination of Urolithiasis.

PURPOSE: This paper aims to develop a clinical decision support system (CDSS) that can help detect the stone that is most important to the diagnosis of urolithiasis. Among them, especially for the development of artificial intelligence (AI) models that support a final judgment in CDSS, we would like to study the optimal AI model by comparing and evaluating them. METHODS: This paper proposes the optimal ureter stone detection model using various AI technologies. The use of AI technology compares and evaluates methods such as machine learning (support vector machine), deep learning (ResNet-50, Fast R-CNN), and image processing (watershed) to find a more effective method for detecting ureter stones. RESULTS: The final value of sensitivity, which is calculated using true positive (TP) and false negative and is a measure of the probability of TP results, showed high recognition accuracy, with an average value of 0.93 for ResNet-50. This finding confirmed that accurate guidance to the stones area was possible when the developed platform was used to support actual surgery. CONCLUSION: The general situation in the most effective way to the detection stone can be found. But a variety of variables may be slightly different the difference through the term could tell. Future works, on urological diseases, are diverse and the research will be expanded by customizing AI models specialized for those diseases.

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

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. CONCLUSION: 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.

Applications of artificial intelligence in urological setting: a hopeful path to improved care.

Artificial intelligence (AI) has been introduced in urology research and practice. Application of AI leads to better accuracy of disease diagnosis and predictive model for monitoring of responses to medical treatments. This mini-review article aims to summarize current applications and development of AI in urology setting, in particular for diagnosis and treatment of urological diseases. This review will introduce that machine learning algorithm-based models will enhance the prediction accuracy for various bladder diseases including interstitial cystitis, bladder cancer, and reproductive urology.

Sophisticated regulation of micturition: review of basic neurourology.

The neurological regulation of the lower urinary tract can be viewed separately from the perspective of sensory neurons and motor neurons. First, in the receptors of the bladder and urethra of sensory nerves, sensations are transmitted through the periaqueductal gray matter of the midbrain to the cerebral cortex, and the cerebrum goes through the process of decision-making. Motor neurons are divided into upper motor neurons (UMNs) and lower motor neurons (LMNs). UMNs coordinate storage and micturition in the brain stem so that synergic voiding can occur. LMNs facilitate muscle contractions in the spinal cord. The muscles involved in urinary storage and micturition are innervated by the somatic branches of sympathetic, parasympathetic, and peripheral nerves. Sympathetic nerves are responsible for contractions of urethral smooth muscles, while parasympathetic nerves originate from S2-S4 and are in charge of contractions of the bladder muscle. Somatic nerves originate from the motor neurons in Onuf's nucleus, which is a specific part of somatic nerves. In this review, we will investigate the structures of the nervous systems related to the lower urinary tract and the regulatory system of innervation for the urinary storage and micturition and discuss the clinical significance and future prospects of neurourological research.

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

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. CONCLUSION: 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.

Development of urination recognition technology based on Support Vector Machine using a smart band.

The purpose of this study was to explore the feasibility of a urination management system by developing a smart band-based algorithm that recognizes the urination interval of women. We designed a device that recognizes the time and interval of urination based on the patient's specific posture and posture changes. The technology used for recognition applied the Radial Basis Function kernel-based Support Vector Machine, a teaching and learning method that facilitates multidimensional analysis by simultaneously judging the characteristics of complex learning data. In order to evaluate the performance of the proposed recognition technique, we compared actual urination and device-sensed urination. An experiment was performed to evaluate the performance of the recognition technology proposed in this study. The efficacy of smart band monitoring urination was evaluated in 10 female patients without urination problems. The entire experiment was performed over a total of 3 days. The average age of the participants was 28.73 years (26-34 years), and there were no signs of dysuria. The final accuracy of the algorithm was calculated based on clinical guidelines for urologists. The experiment showed a high average accuracy of 91.0%, proving the robustness of the proposed algorithm. This urination behavior recognition technique shows high accuracy and can be applied in clinical settings to characterize urination patterns in female patients. As wearable devices develop and become more common, algorithms that detect specific sequential body movement patterns that reflect specific physiological behaviors could become a new methodology to study human physiological behavior.

Irreversible Bladder Remodeling Induced by Fibrosis.

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.

A rare malignant periurethral carcinosarcoma with aggressive behavior: A case treated with a multimodal treatment approach.

Carcinosarcoma is an aggressive tumor that can develop in any organ but is rarely observed in the urinary tract. Given the radioresistant nature of carcinosarcoma and the rapidly regrowing tumor after primary surgery, carcinosarcomas that developed in the body showed poor outcomes regardless of aggressive management. However, the specific optimal treatment for periurethral carcinosarcoma remains unknown. The present study reports a rare case of periurethral carcinosarcoma with metastasis of the skull after receiving surgery for primary tumors with adjuvant concurrent chemoradiation therapy.

Adenosine A2A Receptor Agonist Polydeoxyribonucleotide Alleviates Interstitial Cystitis-Induced Voiding Dysfunction by Suppressing Inflammation and Apoptosis in Rats.

BACKGROUND: Interstitial cystitis (IC) is a chronic disorder that indicates bladder-related pain or discomfort. Patients with IC often experience urination problems, such as urinary frequency and urgency, along with pain or discomfort in the bladder area. Therefore, new treatments based on IC etiology are needed. Polydeoxyribonucleotide (PDRN) is a biologic agonist of the adenosine A2A receptor, and PDRN has anti-inflammatory effect and inhibits apoptosis. In the current study, the effect of PDRN on cyclophosphamide-induced IC animal model was investigated using rats. METHODOLOGY: To induce the IC animal model, 75 mg/kg of cyclophosphamide was injected intraperitoneally once every 3 days for 10 days. The rats in the PDRN-treated groups were intraperitoneally injected with 0.5 mL physiological saline containing 8 mg/kg PDRN, once a day for 10 days after IC induction. RESULTS: Induction of IC by cyclophosphamide injection caused voiding dysfunction, bladder edema, and histological damage. Cyclophosphamide injection increased secretion of pro-inflammatory cytokines and enhanced apoptosis. In contrast, PDRN treatment alleviated voiding dysfunction, bladder edema, and histological damage. Secretion of pro-inflammatory cytokines and expressions of apoptotic factors were suppressed by PDRN treatment. These changes indicate that treatment with PDRN improves voiding function by ultimately promoting the repair of damaged bladder tissue. CONCLUSION: The conclusion of this experiment suggests the possibility that PDRN could be used as an effective therapeutic agent for IC.

Pelvic floor muscle exercise and training for coping with urinary incontinence.

The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.

Stress-Induced Accumulation of HnRNP K into Stress Granules.

Stress granules (SGs) are cytoplasmic aggregates to reprogram gene expression in response to cellular stimulus. Here, we show that while SGs are being assembled in response to clotrimazole, an antifungal medication heterogeneous nuclear ribonucleoprotein (hnRNP) K, an RNA-binding protein that mediates translational silencing of mRNAs, is rapidly accumulated in SGs in U-2OS osteosarcoma cells. Forced expression of hnRNP K induces resistance to clotrimazole-induced apoptosis. Erk/MAPK is transiently activated in response to clotrimazole, and pharmacological suppression of the Erk/MAPK pathway sensitizes the cells to apoptosis. Inhibition of the Erk/MAPK pathway promotes the assembly of SGs. These results suggest that dynamic cytoplasmic formation of SGs and hnRNP K relocation to SGs may be defensive mechanisms against clotrimazole-induced apoptosis in U-2OS osteosarcoma cells.

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

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.