Diagnostic Cystoscopy Research Articles

Migration of an intrauterine contraceptive device into the bladder complicated by stone formation an exceptional complication: case report and literature review

BackgroundWe report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures.Case presentationA 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications.ConclusionThis case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it’s the transuterovesical migration, before concluding wrongly to its expulsion. It’s a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

Outcomes of uterosacral ligaments suspension for uterovaginal prolapse native-tissue repair: Over 1000-patient single-center study

Introduction and hypothesisSurgical repair is the mainstay of genital prolapse management. Among native-tissue apical procedures, high uterosacral ligaments suspension is considered a valid and effective option for central compartment repair. In this study, we aimed to evaluate the effectiveness, complications rate, and functional results of high USL suspension as a primary prolapse repair technique in a large cohort of patients. MethodsPatients who underwent vaginal hysterectomy followed by high uterosacral ligaments suspension for POP between January 2008 and December 2020 were retrospectively analyzed. Questionnaires and clinical interviews were preoperatively performed to assess symptoms and severity of urinary, bowel, and sexual dysfunctions. After surgical procedure, diagnostic cystoscopy was performed to evaluate ureteral patency. Postoperative data, objective, and subjective cure rate were then noted at the follow-up evaluation. ResultsA total of 1099 patients underwent high uterosacral ligaments suspension. The total complication rate was 3.4 % and recurrence in any of the vaginal compartments was 12.4 %. Reoperation for symptomatic prolapse recurrence or pessary treatment was required in 9 women (0.9 %). In the evaluation of postoperative questionnaires, functional outcomes analysis revealed a significant improvement (p < 0.05) in terms of stress urinary incontinence, urge urinary incontinence, voiding symptoms, constipation, and dyspareunia after prolapse repair. ConclusionUterosacral ligament suspension is a safe and effective procedure for primary surgical treatment of pelvic organ prolapse. Anatomical, functional, and subjective outcomes were very satisfactory, and the reoperation rate for recurrence was below 1%.

Optimizing cystoscopy and TURBT: enhanced imaging and artificial intelligence.

Diagnostic cystoscopy in combination with transurethral resection of the bladder tumour are the standard for the diagnosis, surgical treatment and surveillance of bladder cancer. The ability to inspect the bladder in its current form stems from a long chain of advances in imaging science and endoscopy. Despite these advances, bladder cancer recurrence and progression rates remain high after endoscopic resection. This stagnation is a result of the heterogeneity of cancer biology as well as limitations in surgical techniques and tools, as incomplete resection and provider-specific differences affect cancer persistence and early recurrence. An unmet clinical need remains for solutions that can improve tumour delineation and resection. Translational advances in enhanced cystoscopy technologies and artificial intelligence offer promising avenues to overcoming the progress plateau.

Vesicovaginal Fistula Secondary to Left Ectopic Ureter in a 3-Year-Old Female with Left Ureter-Duplication in Tamale Teaching Hospital, Ghana: A Case Report

Purpose: Vesicovaginal fistula (VVF) is a pathological connection between the bladder and vagina, primarily caused by gynaecological surgery, obstructed labour, and cesarean section. VVF significantly impairs quality of life and is prevalent in developing countries, with Africa seeing up to 130,000 new cases annually. Surgical repair, especially transvaginal approaches, remains the primary treatment. Paediatric cases of VVF, often linked to congenital anomalies like ectopic ureter, are rare and complex to manage. Methodology: We report a case of a 3-year-old female with continuous urinary leakage since birth, initially flagged for renal anomalies via prenatal imaging. Clinical examination was normal with no distress or developmental issues. Diagnostic assessments, including abdominal ultrasound and micturating cystourethrogram (MCUG), revealed left hydronephrosis, hydroureter, and a definitive vesicovaginal fistula. A CT Urogram confirmed the diagnosis, showing contrast leakage into the vagina. Findings: Diagnostic cystoscopy revealed a normally positioned right ureteric orifice, while the left was aberrantly positioned near the bladder neck. Culposcopy identified a ureterocele in the posterior fornix of the vagina. During laparotomy, a dilated left distal ureter was observed entering the vagina, indicating true ureter duplication. The surgical intervention involved left ureteric reimplantation using the antireflux method, successfully resolving the anomaly. Post-operative recovery was smooth, with significant improvement in urinary symptoms and no recurrence or complications noted during follow-up. Unique contribution to theory, policy and practice: VVF secondary to ectopic ureter in paediatric patients is rare but manageable with early diagnosis and tailored surgical intervention. Our case underscores the importance of a multidisciplinary approach and the efficacy of ureteral reimplantation in treating complex congenital anomalies, leading to favourable outcomes and symptom resolution.

Intravesical misplacement of vaginal contraceptive ring: a video report and review of the literature.

The NuvaRing®, a hormonal vaginal contraceptive device, has gained widespread usage due to its favourable efficacy and safety profiles. Exceedingly rare instances of unintended misplacement in the bladder have been reported. This study presents a review of the literature and the first video report illustrating the extraction of an intravesical NuvaRing®, discussing diagnostic and therapeutic approaches. To illustrate an effective method for intravesical NuvaRing® retrieval and raise awareness about this unusual complication. A 27-year-old patient with low urinary tract symptoms related to NuvaRing® misplacement underwent diagnostic procedures, including ultrasound and diagnostic cystoscopy. A cystoscopic extraction under general anaesthesia was performed. The effectiveness of pelvic ultrasound for diagnosing an intravesical foreign body, successful cystoscopic removal of NuvaRing® from the bladder, and symptom resolution were assessed. The intravesical NuvaRing® was identified through pelvic ultrasound. During cystoscopy, the ring was detected inside the bladder. Multiple attempts with cystoscopic alligator graspers were made; the NuvaRing® was eventually extracted using transurethral Heiss forceps. The patient experienced minimal blood loss and was discharged the following day, reporting relief from symptoms. Unintentional NuvaRing® placement in the bladder is an extremely rare event that healthcare providers should consider when patients present with urinary symptoms and pelvic pain. Pelvic ultrasound is an efficient diagnostic tool, possibly averting the need for further imaging techniques. Cystoscopy remains the preferred method for diagnosis and treatment. This video report illustrates an effective technique for NuvaRing ® extraction, especially when appropriate graspers are unavailable. Adequate instruction on NuvaRing® insertion should always be emphasised.

Intraoperative Fluorescent Ureter Visualization for Transvaginal High Uterosacral Ligament Suspension for Severe Pelvic Organ Prolapse.

We aimed to demonstrate the feasibility of ureteral navigation using intra-ureteric indocyanine green (ICG) and near-infrared fluorescence (NIRF) imaging during transvaginal high uterosacral ligament suspension for prolapse repair to reduce the risk of iatrogenic ureteral injury. A cystoscope was inserted into the bladder, the tip of a 6-F open-end ureteral catheter was inserted into the ureteral orifices, and ICG was instilled into the ureters. The ureteral path was then clearly identified using NIRF imaging. Sutures were safely placed in the uterosacral ligaments at the level of the ischial spine, taking advantage of direct ureteral visualization. At the end of the procedure, diagnostic cystoscopy was performed to confirm ureteral patency. No intraoperative or postoperative complications were observed. Intra-ureteric ICG-NIRF imaging represents a simple, inexpensive, and reproducible trick for intraoperative ureteral detection, and could reassure surgeons during difficult operations, for instance, in the case of severe prolapse and/or when ureteral course abnormalities are expected.

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

Significance of Suspicious Urine Cytology (Class III) in Diagnostic Cystoscopy Follow-up of Bladder Cancer

(362) Stress Urinary Incontinence Rates in Men Undergoing Optilume Balloon Dilation for Radiation-Induced Posterior Urethral Stenosis: A Single Center Experience

Abstract Introduction While radiation can be a viable treatment option for prostate cancer, development of radiation-induced urethral stenosis occurs in approximately 2% of patients. Optilume, a paclitaxel-coated urethral dilation balloon was FDA approved in 2021 and has shown improved urethral patency and reduced rates of reintervention for anterior urethral strictures relative to standard endoscopic procedures. As the utility of Optilume expands into posterior urethral stenosis, it is important to identify the associated potential complications. Incidence of stress urinary incontinence (SUI) has been reported to be as high as 33% following urethroplasty for patients with radiation-induced urethral stenoses. Rates of SUI following Optilume balloon dilation have yet to be evaluated in this high-risk population. Objective To evaluate rates of SUI in patients undergoing Optilume balloon dilation for radiation-induced posterior urethral stenosis. Methods From March 2022 to February 2023, select men with radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Initial evaluation included retrograde urethrogram and/or diagnostic cystoscopy. Dilation was performed with a 30-French Optilume and left inflated for five minutes per standard protocol. A 16-French catheter was inserted and left in place for three to five days. Patients were scheduled for a three-month post-dilation cystoscopy. Pre- and post-dilation continence rates were compared. Results A total of 16 men with confirmed radiation-induced posterior urethral stenoses underwent Optilume balloon dilation. Of the 16 patients, 12 patients had documentation regarding their pre- and post-treatment continence status. No patients developed de novo SUI. Baseline pre-treatment SUI was noted in one patient (8.3%) requiring an average of 4 Depends per day. This patient noted no change in his degree of SUI following Optilume dilation and the dilation site was found to be widely patent on his follow up cystoscopy. He is scheduled for artificial urinary sphincter in the near future. Mean follow up was 77 days (range 30-180 days). Repeat intervention was required in three patients (18.8%) for repeat stenosis. Conclusions Optilume balloon dilation for radiation-induced posterior urethral stenosis does not appear to lead to de novo SUI in short to intermediate term follow up. Further prospective studies with a larger group of patients and longer follow up duration are warranted in this complex population. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Laborie.

Antibiotic prophylaxis in urologic interventions: Who, when, where?

Periprocedural prophylaxis in medicine encompasses the set of measures (physical, chemical, and pharmacological) used to reduce the risk of infection. Antibiotic prophylaxis (AP) refers to the administration of a short-term regimen of antibiotics shortly before a medical procedure to reduce the risk of infectious complications that can result from diagnostic and therapeutic interventions. The outspreading growth of multidrug-resistant bacterial species and changes in the bacterial local ecosystem have impeded the development of a unique scheme of AP in urology. To review the literature and current guidelines regarding AP for urological diagnostic and therapeutic procedures, and to define agents, timing, and occasions when administering pharmacological prophylaxis. Secondly, according to current literature, to open new scenarios where AP can be useful or useless. Major gaps in evidence still exist in this field. AP appears useful in many invasive procedures and some sub-populations at risk of infectious complications. AP is not routinely recommended for urodynamic exams, diagnostic cystoscopy, and extracorporeal shock-wave lithotripsy. The available data regarding the use of AP during the transperineal prostate biopsy are still unclear; conversely, in the case of the transrectal approach AP is mandatory. AP is still considered the gold standard for the prevention of postoperative infective complications in the case of ureteroscopy, percutaneous nephrolithotomy, endoscopic resection of bladder tumor, endoscopic resection of the prostate, and prosthetic or major surgery. The review highlights the complexity of determining the appropriate candidates for AP, emphasizing the importance of considering patient-specific factors such as comorbidities, immunocompetence, and the nature of the urologic intervention. The evidence suggests that a one-size-fits-all approach may not be suitable, and a tailored strategy based on the specific procedure and patient characteristics is essential.

Assessment of Prostate and Bladder Cancer Genomic Biomarkers Using Artificial Intelligence: a Systematic Review.

The aim of the systematic review is to assess AI's capabilities in the genetics of prostate cancer (PCa) and bladder cancer (BCa) to evaluate target groups for such analysis as well as to assess its prospects in daily practice. In total, our analysis included 27 articles: 10 articles have reported on PCa and 17 on BCa, respectively. The AI algorithms added clinical value and demonstrated promising results in several fields, including cancer detection, assessment of cancer development risk, risk stratification in terms of survival and relapse, and prediction of response to a specific therapy. Besides clinical applications, genetic analysis aided by the AI shed light on the basic urologic cancer biology. We believe, our results of the AI application to the analysis of PCa, BCa data sets will help to identify new targets for urological cancer therapy. The integration of AI in genomic research for screening and clinical applications will evolve with time to help personalizing chemotherapy, prediction of survival and relapse, aid treatment strategies such as reducing frequency of diagnostic cystoscopies, and clinical decision support, e.g., by predicting immunotherapy response. These factors will ultimately lead to personalized and precision medicine thereby improving patient outcomes.

The Variation of Chargemaster Price Listings for Urogynecologic Procedures.

A 2018 Executive Order calling for price transparency required hospitals to publicly provide chargemasters, which are detailed lists of standard price listings for billable medical procedures. The objective of this study was to evaluate price listing variations in common urogynecology procedures. This was a cross-sectional study of chargemasters obtained between February and April 2020 from hospitals across 5 states chosen to reflect the diversity of health systems in the United States. Hospital characteristic and quality metric data were obtained from the Homeland Infrastructure Foundation, U.S. Department of Agriculture, and U.S. Centers for Medicare & Medicaid Services websites. Current Procedural Terminology codes and procedure names for 9 urogynecologic procedures were used to search each chargemaster and extract price listings. Price listings were compared with data on quality, population demographics, and hospital characteristics to determine if any significant relationships existed. Eight hundred thirty-four chargemasters were identified. Price listings for most procedures differed significantly across the 5 states, including colpocleisis, cystoscopy with chemodenervation, diagnostic cystoscopy, diverticulectomy, sacral neuromodulation, midurethral sling, and sacrospinous ligament fixation. Price listings were significantly higher in urban hospitals than rural hospitals for 6 procedures. No significant association was seen with price listing and quality measures for most procedures. Listed prices varied for several urogynecologic procedures. Some of this variation is associated with hospital characteristics such as urban setting. However, notably, price listing was not associated with quality. Further investigation of chargemaster price listings with hospital characteristics and quality metrics and with what is actually paid by patients is imperative for patients to navigate charges.

Implementing routine use of self-removed ureteric stents on extraction strings: prospective patient-reported outcome measures and complications

PurposeUreteric stents placed after ureteroscopy typically require cystoscopy for removal. Stent extraction strings allow the option of patient self-removal. This facilitates shorter stent dwell time, and cost-savings. Concerns regarding safety and limited evidence regarding patient acceptability are speculated reasons for infrequent clinical use of extraction strings. This study investigates our recent experience using routine self-removal of stents on extraction strings to provide evidence to address these concerns.MethodsIn February 2020, our hospital adopted a policy for self-removal of stents on extraction strings to be routine following ureteroscopy. This was influenced by motivation to improve service capacity for diagnostic flexible cystoscopy, hospital avoidance during the pandemic, perceived improvement for the patient experience, and cost-saving. Prospective clinical and patient-reported outcome data were collected and evaluated.ResultsThere were 168 patients who had stents on extraction strings. Mean stent dwell time was 5.2 ± 1.8 days. Primary ureteroscopy was performed in 40.5%, and 59.5% had procedures using an access sheath. Self-removal at home was successful for 79% of patients. Stent dislodgement rate was 3.0% (5/168) and retained stents due to string detachment occurred in 1.8% (3/168). Almost all indicated they “would remove the stent on string again” (90%, 128/142) and the majority reported stent removal as “very easy” (61%, 87/142). Cost modelling estimates a total saving of AUD $148,869 per annum for routine use of extraction strings at our hospital.ConclusionOur experience reflects that stent extraction strings may be used routinely with acceptable low complication rates, favourable patient experiences and associated cost savings.

Vesical calculus: A harbinger for posterior urethral valve?

Bladder stones are of two varieties, primary which are not associated with Urinary Tract Infection (UTI), Bladder Outlet Obstruction (BOO) or foreign bodies and secondary bladder stones which are associated with either or all of the above-mentioned entities. We report three cases of male patients with bladder calculi without any specific history suggestive of BOO since birth. In one of them, posterior urethral valve was found to be the cause of urinary leak on post-operative day 6th after cystolithotomy. In the other two, we had performed cystoscopy before planned cystolithotomy. We recommend through this article that all boys with bladder stones should have diagnostic cystoscopy, especially where endo-urology is available, before proceeding for cystolithotomy.

Use of artificial intelligence in diagnostic cystoscopy of bladder cancer

Background. At the current stage of science and technology development, artificial intelligence (AI) is being actively developed and gradually introduced into the healthcare system.Aim. To perform a literature review to assess the diagnostic value of AI in the detection of bladder cancer at the cystoscopy stage.Materials and methods. We carried out a bibliographic search of articles in Medline and Embase databases using the keywords “artificial intelligence”, “cystoscopy”, “TURBT”.Results. Automated image processing based on AI can improve the accuracy of cancer diagnosis during cystoscopy. According to the studies presented in the review, the sensitivity of AI system for the detection of bladder cancer via cystoscopy can reach 89.7–95.4 %, while its specificity is 87.8–98.6 %, which exceeds the diagnostic capabilities of standard cystoscopy in white light, the sensitivity and specificity of which, according to recent investigations, are approximately 60 and 70 %, respectively. Despite the promising results of these studies, modern science is currently at the stage of developing and evaluating the performance of various AI methods used to analyze cystoscopy images. To date, it would be premature to introduce and widely use these technologies in healthcare, since there are no prospective clinical studies to assess the effectiveness of AI systems in diagnostic cystoscopy and transurethral resection of bladder cancer.Conclusion. Few studies show that AI-based cystoscopy is a promising approach to improvement of the quality of medical care for bladder cancer. Further research is needed to improve the diagnostic capabilities of AI and introduce the obtained technological data into clinical practice.

Abdominopelvic Surgery: Intraoperative Ureteral Injury and Prophylaxis in the United States, 2015-2019.

Preoperative ureteral catheterization/stenting (stenting) and intraoperative diagnostic cystoscopy (cystoscopy) may help prevent or identify intraoperative ureteral injuries (IUIs) during abdominopelvic surgery. In order to provide a comprehensive, single source of data for health care decision makers, this study aimed to catalog the incidence of IUI and rates of stenting and cystoscopy across a wide spectrum of abdominopelvic surgeries. We conducted a retrospective cohort analysis of United States (US) hospital data (October 2015-December 2019). IUI rates and stenting/cystoscopy use were investigated for gastrointestinal, gynecological, and other abdominopelvic surgeries. IUI risk factors were identified using multivariable logistic regression. Among approximately 2.5 million included surgeries, IUIs occurred in 0.88% of gastrointestinal, 0.29% of gynecological, and 1.17% of other abdominopelvic surgeries. Aggregate rates varied by setting and for some surgery types were higher than previously reported, especially in certain higher-risk colorectal procedures. Prophylactic measures were generally employed at a relatively low frequency, with cystoscopy used in 1.8% of gynecological procedures and stenting used in 5.3% of gastrointestinal and 2.3% of other abdominopelvic surgeries. In multivariate analyses, stenting and cystoscopy use, but not surgical approach, were associated with a higher risk of IUI. Risk factors associated with stenting or cystoscopy, as well as those for IUI, largely mirrored the variables reported in the literature, including patient demographics (older age, non-White race, male sex, higher comorbidity), practice settings, and established IUI risk factors (diverticulitis, endometriosis). Use of stenting and cystoscopy largely varied by surgery type, as did rates of IUI. The relatively low use of prophylactic measures suggests there may be an unmet need for a safe, convenient method of injury prophylaxis in abdominopelvic surgeries. Development of new tools, technology, and/or techniques is needed to help surgeons identify the ureter and avoid IUI and the resulting complications.

(490) The Ins and Outs of Peyronie’s Disease: An Evaluation of Endoscopic Associations

Abstract Introduction Peyronie’s disease (PD) is a fibroproliferative disorder of the tunica albuginea of the penis. Though the etiologies and potential mechanisms for PD remain understudied, known PD risk factors include family history, Dupuytren disease, diabetes mellitus, smoking, hypertension, and penile trauma. Endoscopic procedures have also been reported as a cause of PD. Although often referenced, current literature contains little evidence describing the potential association of endoscopic procedures with the development of PD. Objective To evaluate the association of endoscopic procedures and patient demographics in men with the development of Peyronie’s disease Methods Institutional review board approval was obtained, and a retrospective review was performed at a tertiary referral center of all patients with history of urologic endoscopy who were subsequently diagnosed with PD from January 2010 to January 2022. Electronic medical records were searched for ICD-9 and ICD-10 codes to identify unique records with a diagnosis of PD. Records were also identified by CPT codes for transurethral and percutaneous urologic endoscopic procedures. Endoscopic procedures were evaluated for the type of instrumentation and divided into 4 broad categories: diagnostic cystoscopy, urethral stricture manipulation, transurethral resection, and endoscopic treatment for urinary lithiasis. Records were evaluated for time to PD diagnosis following their procedure, presence of a post-operative urethral catheter, and demographic data. Results A total of 19,383 unique patients with endoscopy procedures and 629 unique patients with PD diagnosis were identified. 121 patients had a diagnosis of PD and history of endoscopy, of whom 50 patients (7.9%) were confirmed to have had endoscopy prior to PD diagnosis. The median age of PD diagnosis was 62. There was no increased association between PD and endoscopy in men with a diagnosis of diabetes (p = 0.5261), hypertension (p = 0.2256), or a history of smoking (p = 0.9398). The majority of PD diagnoses (54%, 27/50) were associated with cystoscopy performed supine (48.1%, p=0.0011), in a clinic (40.7%, p = 0.0001), and with flexible instrumentation (55.6%, p&amp;lt;0.0001). Postoperative urethral catheter use was not associated with PD (p = &amp;lt; 0001. There was no association between the time to presentation of PD and the procedure performed (p=0.73). Conclusions Men with a diagnosis of PD and a history of prior urologic endoscopy are more likely to have undergone a simple, flexible cystoscopy in the clinic setting. There does not appear to be an association between the time to presentation of PD and the endoscopic procedure performed. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Endo Pharmaceuticals

Obstructive Fibroepithelial Polyp Mimicking a Tumor in a 3-Year-Old Child

In this article we discusse the case of a 3-year-old child diagnosed with a fibroepithelial polyp of the bladder, a rare benign lesion typically found in infants and children. The child presented with hematuria, suprapubic pain, and dysuria, and an ultrasound revealed a tumor-like vesical process obstructing the left ureteral meatus and causing moderate ipsilateral hydronephrosis. The presence of vascularity on color Doppler raised concerns of a malignancy such as vesical rhabdomyosarcoma or inflammatory pseudotumor. Diagnostic and therapeutic cystoscopy revealed a left ureteral polyp, and complete resection was performed. The pathological examination suggested an inflammatory pseudopolyp, and the patient's outcome was positive. The article discusses the rarity of this condition in children, its clinical symptoms, diagnosis, and management.

Vaginal Atresia, Left Unicornuate Unicollis Uterus, Left Pelvic Ectopic Single Kidney with Right Inguinal Hernia Containing Ovary in a 14 y Old Female: A Rare MRKHS Variant

Introduction: Vaginal atresia is a component of Mayer–Rokitansky–Küster–Hauser syndrome (MRKHS), which includes variable Mullerian duct abnormalities with normal secondary sexual characteristics. Associated renal anomalies are present in about 30% of cases(1)&#x0D; Objective: To present a rare variant of MRKHS in a14-y old female with a right ovary in a right inguinal hernia and renal anomalies managed bysigmoid vaginoplasty.&#x0D; Case Description: A 14-year-old girl presented with primary amenorrhea and cyclic abdominal painone year before, pelviabdominal swelling, right inguinal hernia, and well-developed secondary sexual characteristics with a single introital opening. Investigations revealed a left ectopic pelvic single kidney, hematometra with left hematosalpinx and right-sided inguinal hernia containing the right ovary with a left ovarian cyst. The first procedure included diagnostic laparoscopy and cystoscopy with the combined repair of the right-sided inguinal hernia and laparoscopic drilling of the left ovarian chocolate cyst. The patient was diagnosed with unicornuate unicollis uterus, left hematosalpinx with complete vaginal atresia associated with a left ectopic pelvic single kidney. One month later, sigmoid vaginoplasty was done. At the 3-month follow-up, there was a full-thickness neovaginal prolapse which was managed surgically by resection.&#x0D; Conclusion: To our knowledge, this is the first description of this variant of MRKH syndrome association, includingvaginal atresia, left unicornuate unicollis uterus with ipsilateral left single pelvic ectopic kidney with right-sided inguinal hernia containing right ovary, in the literature. Renal assessment in cases of vaginal atresia and other mullerian anomalies is mandatory for detecting and managing such anomalies and preserving renal function. Anatomical and functional assessment of the urogenital system is mandatory, and multiple modalities can be integrated to get proper results. Diagnostic laparoscopy and cystoscopy give invaluable information in these cases and can add therapeutic aids.

MP60-18 EFFICIENT AUGMENTED INTELLIGENCE STRATEGY WITH POTENTIAL USE FOR REAL-TIME BLADDER TUMOR DETECTION

You have accessJournal of UrologyCME1 Apr 2023MP60-18 EFFICIENT AUGMENTED INTELLIGENCE STRATEGY WITH POTENTIAL USE FOR REAL-TIME BLADDER TUMOR DETECTION Okyaz Eminaga, Timothy Lee, Mark Laurie, Jessie Ge, Vinh LA, Jin Long, Eugene Shkolyar, Xiao Jia, Axel Semjonow, Martin Bogemann, Hubert Lau, Lei Xing, and Joseph Liao Okyaz EminagaOkyaz Eminaga More articles by this author , Timothy LeeTimothy Lee More articles by this author , Mark LaurieMark Laurie More articles by this author , Jessie GeJessie Ge More articles by this author , Vinh LAVinh LA More articles by this author , Jin LongJin Long More articles by this author , Eugene ShkolyarEugene Shkolyar More articles by this author , Xiao JiaXiao Jia More articles by this author , Axel SemjonowAxel Semjonow More articles by this author , Martin BogemannMartin Bogemann More articles by this author , Hubert LauHubert Lau More articles by this author , Lei XingLei Xing More articles by this author , and Joseph LiaoJoseph Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Development of intelligence systems for bladder tumor detection is cost- and labor-intensive. Specifically, image annotation is one of the most expensive tasks in the development of intelligence systems. Moreover, previous studies utilized selective screenshots or frame sequences for model development and validation, despite that cystoscopy is a dynamic visual inspection impacted by random noises. The current work proposes an efficient strategy to develop augmented intelligence strategy ready for real-time bladder tumor detection as computer-aided assistance tool for clinicians. METHODS: We used a previously published educational cystoscopy atlas (n=312 images) and our deep learning models (ConvNeXt, PlexusNet, MobileNet, SwinTransformer) covering a variety of model complexity and computation efficacy to estimate the ratio between cancer and normal confidence scores; We applied an image augmentation strategy called RandAugment to populate the training set for model training and externally validated on video records for the initial diagnostic cystoscopy prior to TURBT from 68 cases with benign and bladder cancers tumors (i.e., region of interest, ROI) at a single center. Each frame of the video was labeled by ROI status. ROI was confirmed by pathology examination and the Delphi method. The ROI status was predicted based on the ratio (if the ratio>1, then the frame is positive for ROI, otherwise negative). On external validation, areas of adequate illumination in video frames were considered as input for models. The performance measurement included specificity and sensitivity at frame level, frame sequence (block) level, and ROI level for each case. The block level split each full-length video into small segments according to the ROI status. RESULTS: Specificity was statistically comparable between four models at frame (range: 30.0–44.8%) and block levels (56–67%) by p>0.05. While sensitivity at frame level (range: 81.4 – 88.1) statistically differed between the models, sensitivity at block level (100%) and ROI level (100%) were comparable between these models, indicating that all ROI are detectable by these models and that the frame-level model performance is impacted by the random noises. MobileNet and PlexusNet were computationally more efficient (22 and 19 frames per second, retrospectively) and suitable for real-time detection task than ConvNeXt and SwinTransformer (13 and 17 frames per second, retrospectively). CONCLUSIONS: Educational cystoscopy atlas and cost-effective model development strategy facilitates the development of accurate and efficient intelligence systems with potential use for real-time bladder tumor detection. Source of Funding: The work was supported by National Institutes of Health R01 CA260426 to JCL. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e850 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Okyaz Eminaga More articles by this author Timothy Lee More articles by this author Mark Laurie More articles by this author Jessie Ge More articles by this author Vinh LA More articles by this author Jin Long More articles by this author Eugene Shkolyar More articles by this author Xiao Jia More articles by this author Axel Semjonow More articles by this author Martin Bogemann More articles by this author Hubert Lau More articles by this author Lei Xing More articles by this author Joseph Liao More articles by this author Expand All Advertisement PDF downloadLoading ...

MP63-02 PROSPECTIVE MULTI-INSTITUTIONAL VALIDATION OF a 3-GENE mRNA BIOMARKER PANEL FOR DETECTION AND SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP63-02 PROSPECTIVE MULTI-INSTITUTIONAL VALIDATION OF a 3-GENE mRNA BIOMARKER PANEL FOR DETECTION AND SURVEILLANCE OF NON-MUSCLE INVASIVE BLADDER CANCER Zachary Kornberg, Eugene Shkolyar, Kathleen E. Mach, Timothy J. Lee, Vinh LA, Ihna Yoo, Gabriela Rodriguez, Amy D. Dobberfuhl, Eila C. Skinner, John T. Leppert, and Joseph C. Liao Zachary KornbergZachary Kornberg More articles by this author , Eugene ShkolyarEugene Shkolyar More articles by this author , Kathleen E. MachKathleen E. Mach More articles by this author , Timothy J. LeeTimothy J. Lee More articles by this author , Vinh LAVinh LA More articles by this author , Ihna YooIhna Yoo More articles by this author , Gabriela RodriguezGabriela Rodriguez More articles by this author , Amy D. DobberfuhlAmy D. Dobberfuhl More articles by this author , Eila C. SkinnerEila C. Skinner More articles by this author , John T. LeppertJohn T. Leppert More articles by this author , and Joseph C. LiaoJoseph C. Liao More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Risk stratification for patients with non-muscle invasive bladder cancer (NMIBC) is essential for treatment planning. Urinary biomarkers based on mRNA are a promising non-invasive modality for potential augmentation of current detection and surveillance methods. Previously we reported a 3-gene mRNA panel strongly associated with bladder cancer (BCa) showing promise as a screening and surveillance assay. Here we validate the performance of this assay prospectively in a multi-institution cohort to further demonstrate its potential utility in the management of NMIBC. METHODS: Urine samples were collected from patients undergoing BCa screening and surveillance between 2016 and 2022 at Stanford University and the Veterans Affairs Palo Alto Health Care System. Patients with lesions concerning for bladder cancer on cystoscopy underwent transurethral resection, with stage and grade determined by histopathologic diagnosis. BCa incidence were categorized by AUA risk stratification. Voided urine samples were collected, centrifuged, and RNA was isolated from the pellet. qPCR was performed to evaluate expression of ROBO1, CRH, and IGF2. Assay positivity was evaluated via previously published formula, and sensitivity and specificity for the detection of any BCa, as well as increased-risk disease (AUA intermediate and high-risk NMIBC), were determined. RESULTS: 216 patients provided urine samples at time of diagnostic cystoscopy, and 233 patients provided 587 samples at surveillance cystoscopies. In the detection cohort, 88 new cancers were diagnosed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the biomarker panel for any BCa was 1, 0.43, 0.53, and 1 respectively. In the surveillance cohort 189 recurrences occurred. For detection of any recurrence, the sensitivity, specificity, NPV, and PPV of the biomarker panel were 0.97, 0.24, 0.41, and 0.96, and for increased-risk disease, were 0.98, 0.25, 0.36, and 0.96 respectively. Using this assay, 59 cystoscopies (25%) could have been avoided in the detection group without missing a single incidence of BCa, and 96 cystoscopies (17%) could have been avoided in the surveillance group while missing only 4 increased-risk BCas. CONCLUSIONS: The 3-gene urinary mRNA biomarker panel shows high sensitivity for detection of NMIBC in an extended patient cohort. With further validation in prospective trials, this panel may facilitate biomarker-informed BCa screening and surveillance. Source of Funding: Department of Veterans Affairs BLR&D Merit Review I01 BX004962 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e871 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zachary Kornberg More articles by this author Eugene Shkolyar More articles by this author Kathleen E. Mach More articles by this author Timothy J. Lee More articles by this author Vinh LA More articles by this author Ihna Yoo More articles by this author Gabriela Rodriguez More articles by this author Amy D. Dobberfuhl More articles by this author Eila C. Skinner More articles by this author John T. Leppert More articles by this author Joseph C. Liao More articles by this author Expand All Advertisement PDF downloadLoading ...