Search Results (11)

Background: Vesicoureteral reflux (VUR) is a common pediatric urological disorder traditionally diagnosed by voiding cystourethrography (VCUG). Although ureteric orifice (UO) morphology during cystoscopy correlates with VUR severity, its assessment remains subjective. To our knowledge, artificial intelligence (AI) has not previously been applied to cystoscopic images for VUR prediction. We aimed to develop and evaluate the first AI model for predicting VUR from pediatric cystoscopic images and videos. Methods: In this retrospective single-center study, cystoscopic videos from children with and without VUR diagnosed by VCUG were analyzed. Individual frames were extracted, anonymized and annotated according to VUR grade. Four YOLOv12 object detection models were trained to classify UOs as no/grade I, low-grade (grades II–III), or high-grade (grades IV–V) VUR. To better understand sources of model failure, additional experiments evaluated binary image classification and class-agnostic UO localization. Finally, frame-level predictions were aggregated across complete cystoscopic sequences using majority voting to assess UO-level performance. Results: Three-class object detection demonstrated limited frame-level performance, with a maximum mAP@50 of 0.37 and mAP@50–95 of 0.17. Binary classification achieved a macro precision of 0.62, recall of 0.58, and F1 score of 0.49. Class-agnostic object detection improved localization performance (mAP@50 0.63). Aggregating predictions across complete video sequences substantially improved diagnostic performance, achieving UO-level accuracies of up to 77%, with leave-one-out cross-validation accuracies ranging from 0.69 to 0.77. Conclusions: This proof-of-concept study demonstrates the feasibility of AI-assisted VUR prediction from pediatric cystoscopic videos. While frame-level performance was limited, sequence-level aggregation markedly improved diagnostic accuracy, highlighting the importance of temporal information for future video-based AI models in pediatric endourology. Full article

Background/Objectives: Double-J stents (DJS) cause clinically significant lower urinary tract symptoms (LUTS) in 58–80% of patients following ureteroscopy (URS). The distal vesical coil is regarded as the primary anatomical source of trigonal irritation and detrusor instability. The single-J stent (SJS) eliminates this element while preserving the proximal renal pigtail for anti-migration anchorage. This study aimed to evaluate the safety and patient-reported symptom outcomes of a modified SJS compared with standard DJS following elective URS for ureteric stone disease. Methods: A prospective, single-arm, within-patient feasibility study was conducted in 28 adults undergoing elective URS at Austin Health, Melbourne, Australia (Human Research Ethics Committee (HREC)/25658/Austin-2025; NCT07535580). A modified SJS was fashioned from a commercially available 7Fr Bander™ ureteral diversion stent (Cook Medical, G14780) by trimming the shaft to 28 cm and affixing a 7 cm Prolene retrieval suture (Ethicon NW807) to the blunt distal end. The primary outcome was a cystoscopically confirmed SJS migration rate at removal (pre-specified feasibility threshold ≤5%). Secondary outcomes included change in Ureteral Stent Discomfort Test (USDT) total and domain scores (paired analysis, n = 24), adverse events, and patient preference. Results: The clinically significant migration rate was 0% (0/28); 27/28 stent tips were freely floating within the bladder, with one asymptomatic tip at the ureteric orifice at the scheduled removal visit. Mean total USDT score decreased from 39.92 ± 2.00 (DJS) to 30.42 ± 1.73 (SJS)—a mean absolute reduction of 9.50 points (23.8%; p < 0.001), a magnitude consistent with clinically relevant change, although a USDT-specific minimum clinically important difference has not been independently validated. All six USDT domains improved significantly (all p ≤ 0.014). No adverse events were recorded. All 28 patients (100%) reported they would choose the SJS again. Conclusions: The modified SJS demonstrated a favourable safety profile and was associated with lower patient-reported symptom scores than the preceding DJS across all USDT domains in this uncontrolled within-patient comparison. Because stent design, stone burden, and dwell time differed between the two assessment phases, these differences should be regarded as hypothesis-generating and provide a feasibility basis for a prospective randomised controlled trial evaluating the SJS following URS. Full article

Background and Clinical Significance: Endoscopic ureterocele incision is the preferred initial treatment for ureteroceles associated with duplex collecting systems due to its capability for rapid decompression via a minimally invasive technique with generally favorable outcomes among pediatric patients. However, the postoperative trajectory in children with solitary functioning renal units remains inadequately characterized. We present a severe, yet reversible, case of postrenal acute kidney injury (AKI) following endoscopic ureterocele incision in an infant with a contralateral multicystic dysplastic kidney (MCDK). This case emphasizes the pathophysiological implications of failed ureterocele decompression and the vital importance of rigorous postoperative monitoring. Case Presentation: A female infant with a right MCDK and a left duplex collecting system featuring an upper pole ureterocele underwent transurethral endoscopic incision due to progressive hydronephrosis. Within 24 h following surgery, the patient exhibited oliguria, oedema, worsening hydronephrosis, hyponatremia (125 mmol/L), metabolic acidosis, and increasing serum creatinine levels, indicative of postrenal AKI. Arterial blood gas analyses indicated severe renal-driven metabolic acidosis with bicarbonate levels of 13.9 mmol/L, accompanied by respiratory compensation and normal lactate levels. Imaging studies revealed deteriorating hydronephrosis of the upper and lower poles of the left kidney. Emergency open nephrostomy placement in the lower pole, after failed jj insertion in the lower pole ureteral orifice, resulted in the immediate restoration of urinary drainage and progressive biochemical recovery. The patient required a brief period of intensive care monitoring, followed by hospitalization in pediatric and urological departments. Longitudinal imaging demonstrated persistent but stable upper pole dilatation with preserved parenchyma. Definitive management was later achieved through right nephrectomy of the non-functioning MCDK. Conclusions: In patients with solitary functioning renal units, the endoscopic ureterocele incision may result in postoperative local oedema, potentially leading to clinically significant obstructive AKI. This case underscores the necessity for intensified surveillance and individualized postoperative management strategies in anatomically complex pediatric patients. Full article

Objective: To enhance the information modeling capacity of large-kernel convolutional neural networks and to build a ureteral orifice detection framework for ureteroscopic imaging. Methods: A retrospective dataset of ureteroscopic images from 222 patients was collected. The patients were randomly divided into training and testing sets at a ratio of 7:3. Initially, video files were converted into image frames, and feature-relevant images were manually labeled by physicians. Subsequently, a ConvNeXt-based backbone augmented with squeeze-and-excitation (SE) modules was employed to extract diverse deep features. SCConv modules were incorporated across stages to strengthen the network’s feature extraction performance. Lastly, enhanced spatial excitation attention mechanisms were cascaded to achieve superior feature fusion and detection accuracy. Comparative experiments were conducted against baseline models, including ConvNeXt, assessing accuracy, computational overhead, and inference latency. Results: On a test set of 491 ureteroscopic images, all models achieved mAP@50 values above 0.75, whereas the proposed network achieved 0.890, markedly exceeding baseline performance. The model operated at 20 ms per frame, achieving a frame rate of 50 FPS. Conclusions: We developed an improved deep learning framework based on large-kernel convolutional networks for real-time ureteral orifice detection in endoscopic scenarios. This system achieves a favorable balance between detection accuracy and real-time efficiency. The method demonstrates significant potential as a training and feedback tool for residents and junior urologists in clinical environments. Full article

Background/Objectives: For centuries, humans have employed animal models to progress biomedical science, to understand pathological and biological processes, and to develop and test drugs, vaccines, and surgical techniques. In the field of urology, Sampaio and his colleagues from Brazil were the pioneers in proposing that the porcine model is the most accurate representation of the human kidney. We aim to describe the relevant urinary anatomy of female Landrace pigs based on endoscopy and computed tomography (CT) scans and compare differences between the urinary anatomy of pigs and humans. Methods: Four white Landrace female pigs were used for the study: two for CT imaging and two for endoscopic assessment. CT-urograms were performed using a 64-channel tomography machine with 0.625 mm thick slices. For the endoscopic procedure, the intravaginal urethral meatus was cannulated using a cystoscope, followed by complete urethrocystoscopy. The ureteric orifices were then cannulated, and a retrograde pyelogram was performed, followed by ureterorenoscopy. The analyses were performed using SPSS (Version 28), and simulated data was created using R (version 3.5.0), with the significance set at p ≤ 0.05. The data obtained from two pigs was used to simulate an empirical data with 500 observations, using the mean and standard deviations from our n = 2 to produce a random normal distribution. Results: CT and endoscopic findings showed two multirenculate multipapillate kidneys, each receiving blood supply from a single renal artery that is further divided into cranial and caudal branches. The delayed phase of the urogram showed distal ureters passing posterior to the bladder and emptying into the bladder at the base. Urethroscopy revealed an intravaginal urethral meatus ventral to the anus, positioned midway between the mucocutaneous junction of the vulva and the cervix. Endoscopic view of the bladder neck showing patulous ureteric orifices at the bladder neck with no distinct interureteric ridge or trigone. Retrograde pyelogram showed a Group B drainage pattern in both pigs. Conclusions: While there are numerous similarities between the urinary systems of humans and pigs, there are important subtle differences that urologists and researchers need to be mindful of before using the porcine model for urological research and training. Full article

Urinary bladder hamartoma is an exceptionally rare benign lesion composed of disorganized yet mature tissue elements native to the bladder, including urothelium, fibrous stroma, smooth muscle, and occasionally adipose tissue. Unlike malignant tumors, it lacks cytological atypia, mitotic activity, or necrosis. Patients most often present with lower urinary tract symptoms (LUTS) or hematuria, though some cases are incidental findings. Associations with syndromic conditions such as Peutz–Jeghers, Beckwith–Wiedemann, Goldenhar, and Loeys–Dietz have been reported. Transurethral resection is the preferred treatment and has generally been curative. We report the first case in Germany—and the 16th worldwide—of urinary bladder hamartoma, occurring in a young adult male with bothersome LUTS. Because of its proximity to both ureteral orifices, only partial transurethral resection was performed, which provided durable symptom relief at 14 months of follow-up. This case highlights partial TUR as a pragmatic, organ-preserving alternative when complete resection is anatomically unsafe, while emphasizing that TURBT remains the standard of care. We provide a detailed discussion of the histopathological features, differential diagnosis, treatment considerations, and an updated narrative review of all reported cases. Full article

An adult female bottlenose dolphin (Tursiops truncatus) housed at a public oceanarium presented with acute anorexia and lethargy. A blood analysis demonstrated mild leukocytosis, marked azotemia, hyperkalemia, and hyperphosphatemia suggestive of acute kidney injury or renal insufficiency. Ultrasound examination of the dolphin revealed ascites, pleural effusion, bilateral nephrolithiasis, mild hydronephrosis, and bilateral hydroureter consistent with bilateral post-renal obstruction. Initial treatment consisted of antibiotics, oral fluids, and anti-inflammatory treatment. Further imaging diagnosed bilateral obstructing ureteroliths at both ureteral orifice junctions of the urinary bladder. The dolphin’s azotemia and hyperkalemia were nonresponsive to traditional medical management; therefore, peritoneal dialysis was performed for emergent clinical stabilization. Peritoneal dialysis was conducted over 3 days and facilitated the patient to undergo laser lithotripsy of the offending ureteral obstruction. The dolphin made a full recovery following months of intensive medical treatment for complications from peritoneal dialysis and secondary peritonitis. This is the first documented case of successful, though complicated, peritoneal dialysis in a cetacean. Full article

Urinary bladder diverticula are formed by the herniation of the mucosa into the muscle layer of the bladder wall, often ending with a narrow neck that communicates with the bladder lumen. They may be congenital or acquired, and they most often affect males. Urinary bladder diverticula discovery during autopsy incidence described in the literature is approximately 5–10%. Various causative factors have been described, including urinary tract obstruction (e.g., benign prostate hyperplasia) and neurogenic and iatrogenic causes. The most described site of occurrence is adjacent to the ureteral orifice. Their clinical presentation does not often facilitate diagnosis, as most are small and asymptomatic. Complications of urinary bladder diverticulosis include infections, lithiasis, neoplasia, pressure on adjacent tissues, obstruction, and rupture. Indeed, urinary bladder diverticula may lead to spontaneous bladder rupture in extremely rare cases. This paper presents the case of an 87-year-old female suffering from atrial fibrillation and under anticoagulant therapy who was pronounced dead in a hospital and was subsequently referred to our department for medico-legal examination. Upon macroscopic examination of the body, intra-abdominal hemorrhage was observed in the vicinity of the urinary bladder, extraperitoneally. A meticulous examination excluded the possibility of injury as the cause of this finding, and tissue samples were collected for histopathological examination. A ruptured urinary diverticulum was discovered and confirmed histopathologically. Death was attributed to intra-abdominal hemorrhage after rupture of urinary bladder diverticulum. A forensic pathologist should be aware of this diagnosis, as although extremely rare, such pathology may lead to death, especially when the patient is under anticoagulant therapy. Full article

Background and Purpose: In urological surgery, accurate localization of the ureteral orifice is crucial for procedures such as ureteral stent insertion, assessment of ureteral orifice lesions, and prostate tumor resection. Consequently, we have developed and validated a computer-assisted ureteral orifice detection system that combines the YOLO deep convolutional neural network and the attention mechanism. Data: The cases were partitioned into a training set and a validation set at a 4:1 ratio, with 84 cases comprising 820 images in the training set and 20 cases containing 223 images in the validation set. Method: We improved the YOLO network structure to accomplish the detection task. Based on the one-stage strategy, we replaced the backbone of YOLOv5 with a structure composed of ConvNeXt blocks. Additionally, we introduced GRN (Global Response Normalization) modules and SE blocks into the blocks to enhance deep feature diversity. In the feature enhancement section, we incorporated the BiFormer attention structure, which provides long-distance context dependencies without adding excessive computational costs. Finally, we improved the prediction box loss function to WIoU (Wise-IoU), enhancing the accuracy of the prediction boxes. Results: Testing on 223 cystoscopy images demonstrated a precision of 0.928 and recall of 0.756 for our proposed ureteral orifice detection network. With an overlap threshold of 0.5, the mAP of our proposed image detection system reached 0.896. The entire model achieved a single-frame detection speed of 5.7 ms on the platform, with a frame rate of 175FPS. Conclusion: We have enhanced a deep learning framework based on the one-stage YOLO strategy, suitable for real-time detection of the ureteral orifice in endoscopic scenarios. The system simultaneously maintains high accuracy and good real-time performance. This method holds substantial potential as an excellent learning and feedback system for trainees and new urologists in clinical settings. Full article

We have demonstrated in canines that somatic nerve transfer to vesical branches of the inferior hypogastric plexus (IHP) can be used for bladder reinnervation after spinal root injury. Yet, the complex anatomy of the IHP hinders the clinical application of this repair strategy. Here, using human cadavers, we clarify the spatial relationships of the vesical branches of the IHP and nearby pelvic ganglia, with the ureteral orifice of the bladder. Forty-four pelvic regions were examined in 30 human cadavers. Gross post-mortem and intra-operative approaches (open anterior abdominal, manual laparoscopic, and robot-assisted) were used. Nerve branch distances and diameters were measured after thorough visual inspection and gentle dissection, so as to not distort tissue. The IHP had between 1 to 4 vesical branches (2.33 ± 0.72, mean ± SD) with average diameters of 0.51 ± 0.06 mm. Vesical branches from the IHP arose from a grossly visible pelvic ganglion in 93% of cases (confirmed histologically). The pelvic ganglion was typically located 7.11 ± 6.11 mm posterolateral to the ureteral orifice in 69% of specimens. With this in-depth characterization, vesical branches from the IHP can be safely located both posterolateral to the ureteral orifice and emanating from a more proximal ganglionic enlargement during surgical procedures. Full article

Objective: To define predictors for initial retrograde ureteral stenting (RUS) failure with the need for the percutaneous nephrostomy (PCN) insertion as a drainage method in patients with complicated acute calculus obstructive uropathy. Methods: We undertook a retrospective evaluation of patients who presented with complicated obstructive calculus uropathy (acute renal failure or obstructive pyelonephritis) between January 2016 and January 2020. Patients in whom there was failure to visualize ipsilateral ureteric orifice and those with extrinsic ureteral obstruction were excluded. Patient demographics and radiological data including stone site, hydronephrosis grade, maximum transverse stone diameter, periureteral density (PUD) and pericalcular ureteric thickness (P-CUT) at the maximum transverse stone diameter were assessed using non-contrast computed tomography at the time of admission. Results: The study included 256 patients who were managed initially by RUS trial. Of them, 48 (18.8 %) had RUS failure. The presence of acute pyelonephritis, increased maximum transverse stone diameter ≥ 9.5 mm, P-CUT ≥ 7.5 mm, and PUD at stone level ≥ 17.5 HU were risk factors associated with RUS failure (P = 0.007, 0.002, <0.001, and <0.001, respectively). Conclusion: Initial radiological stone and ureteric characteristics, in addition to the clinical diagnosis of obstructive pyelonephritis, can be used to determine PCN insertion as the preferred option over RUS for urinary drainage. Full article