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Deep Learning Model for Real‑time Semantic Segmentation During Intraoperative Robotic Prostatectomy.European Urology Open Science Apr 2024Recently, deep learning algorithms, including convolutional neural networks (CNNs), have shown remarkable progress in medical imaging analysis. Semantic segmentation,...
BACKGROUND AND OBJECTIVE
Recently, deep learning algorithms, including convolutional neural networks (CNNs), have shown remarkable progress in medical imaging analysis. Semantic segmentation, which segments an unknown image into different parts and objects, has potential applications in robotic surgery in areas where artificial intelligence (AI) can be applied, such as in AI-assisted surgery, surgeon training, and skill assessment. We aimed to investigate the performance of a CNN-based deep learning model in real-time segmentation in robot-assisted radical prostatectomy (RALP).
METHODS
Intraoperative videos of RALP procedures were obtained. The reinforcement U-Net model was used for segmentation. Segmentation of the images of instruments, bladder, prostate, and seminal vesicle-vas deferens was performed. The dataset was preprocessed and split randomly into training, validation, and test data in a 7:2:1 ratio. Dice coefficient, intersection over union (IoU), and accuracy by class, which are commonly used in medical image segmentation, were calculated to evaluate the performance of the model.
KEY FINDINGS AND LIMITATIONS
From 120 patient videos, 2400 images were selected for RALP procedures. The mean Dice scores for the identification of the instruments, bladder, prostate, and seminal vesicle-vas deferens were 0.96, 0.74, 0.85, and 0.84, respectively. Overall, when applied to the test data, the model had a mean Dice coefficient value of 0.85, IoU of 0.77, and accuracy of 0.85. Limitations included the sample size, lack of diversity in the methods of surgery, incomplete surgical processes, and lack of external validation.
CONCLUSIONS AND CLINICAL IMPLICATIONS
The CNN-based segmentation provides accurate real-time recognition of surgical instruments and anatomy in RALP. Deep learning algorithms can be used to identify anatomy within the surgical field and could potentially be used to provide real-time guidance in robotic surgery.
PATIENT SUMMARY
We demonstrate the potential effectiveness of deep learning segmentation in robotic prostatectomy procedures. Deep learning algorithms could be used to identify anatomical structures within the surgical field and may provide real-time guidance in robotic surgery.
PubMed: 38585210
DOI: 10.1016/j.euros.2024.02.005 -
Cureus Mar 2024Infertility affects couples worldwide. Among these, obstructive azoospermia (OA) is a common cause. In some cases, the lack of spermatozoa in ejaculation results from...
Infertility affects couples worldwide. Among these, obstructive azoospermia (OA) is a common cause. In some cases, the lack of spermatozoa in ejaculation results from blockages in the male reproductive tract. In this case study, we discuss an infertile male diagnosed with OA following three years of unsuccessful attempts at conception. The male had a history of bilateral inguinal hernia repair due to congenital bilateral absence of the vas deferens. Diagnostic assessments confirmed azoospermia. Microscopic epididymal sperm aspiration (MESA) was performed for sperm retrieval due to its efficacy and reduced postoperative pain, testicular atrophy, and decreased testosterone levels. The retrieved sperm was processed using SpermMobil media for intracytoplasmic sperm injection. Following successful fertilization, embryo transfers resulted in a positive pregnancy test. This case highlights the significance of specific treatment approaches for OA, specifically the effectiveness of MESA and SpermMobil in achieving successful outcomes in assisted reproduction technology for male infertility.
PubMed: 38559533
DOI: 10.7759/cureus.55323 -
Disease Models & Mechanisms Mar 2024International Women's Day 2024 has a theme of inclusion. As publishers of preclinical research, we aim to show how inclusion of females in research advances scientific...
International Women's Day 2024 has a theme of inclusion. As publishers of preclinical research, we aim to show how inclusion of females in research advances scientific rigor and improves treatment reliability. Sexual reproduction is key to all life across the plant and animal kingdoms. Biological sex takes many forms that are morphologically differentiated during development: stamens versus pistils in plants; color and plumage in birds; fallopian tubes versus vas deferens in mammals; and differences in size, for instance, males are smaller in the fruit fly Drosophila melanogaster. Physical differences may be obvious, but many traits may be more obscure, including hormonal, physiological and metabolic factors. These traits have a big influence on disease and responses to treatment. Thus, we call for improved inclusion, analysis and reporting of sex as a biological variable in preclinical animal modeling research.
Topics: Animals; Male; Humans; Female; Drosophila melanogaster; Reproducibility of Results; Drosophila; Fallopian Tubes; Phenotype; Mammals; Drosophila Proteins; DEAD-box RNA Helicases
PubMed: 38450661
DOI: 10.1242/dmm.050759 -
Frontiers in Cell and Developmental... 2024Over 8% of couples worldwide are affected by infertility and nearly half of these cases are due to male-specific issues where the underlying cause is often unknown....
Over 8% of couples worldwide are affected by infertility and nearly half of these cases are due to male-specific issues where the underlying cause is often unknown. Therefore, discovery of new genetic factors contributing to male-specific infertility in model organisms can enhance our understanding of the etiology of this disorder. Here we show that murine ATP10A, a phospholipid flippase, is highly expressed in male reproductive organs, specifically the testes and vas deferens. Therefore, we tested the influence of ATP10A on reproduction by examining fertility of knockout mice. Our findings reveal that deficiency leads to male-specific infertility, but does not perturb fertility in the females. The deficient male mice exhibit smaller testes, reduced sperm count (oligozoospermia) and lower sperm motility (asthenozoospermia). Additionally, deficient mice display testes and vas deferens histopathological abnormalities, as well as altered total and relative amounts of hormones associated with the hypothalamic-pituitary-gonadal axis. Surprisingly, circulating testosterone is elevated 2-fold in the knockout mice while luteinizing hormone, follicle stimulating hormone, and inhibin B levels were not significantly different from WT littermates. The knockout mice also exhibit elevated levels of gonadotropin receptors and alterations to ERK, p38 MAPK, Akt, and cPLA-dependent signaling in the testes. was knocked out in the C57BL/6J background, which also carries an inactivating nonsense mutation in the closely related lipid flippase, We have corrected the nonsense mutation using CRISPR/Cas9 and determined that loss of alone is sufficient to cause infertility in male mice. Collectively, these findings highlight the critical role of ATP10A in male fertility in mice and provide valuable insights into the underlying molecular mechanisms.
PubMed: 38415274
DOI: 10.3389/fcell.2024.1310593 -
JBRA Assisted Reproduction Feb 2024Recently, it has been discussed whether or not mosaic embryo transfers should be performed since they might result in viable pregnancies, although they often end up...
OBJECTIVE
Recently, it has been discussed whether or not mosaic embryo transfers should be performed since they might result in viable pregnancies, although they often end up being discarded. We report a case of successful pregnancy, after a mosaic embryo transfer from an in vitro matured egg and frozen PESA sperm.
CASE DESCRIPTION
Tests performed on a female aged 40 years and a male aged 37 years seeking fertility treatment found she had an adequate ovarian reserve and patent fallopian tubes. He had a history of cryptorchidism and inguinal hernia repair. The spermogram showed azoospermia, and testicular ultrasound showed an atrophic left testicle and a normal right testis. The vas deferens was palpated during physical examination. Intracytoplasmic sperm injection with percutaneous epididymal sperm aspiration (PESA) was indicated. Two cycles of IVF after controlled ovarian stimulation with follitropin delta was performed. In the first cycle, seven mature eggs were inseminated, two fertilized normally, resulting in one blastocyst biopsied and analyzed by NGS with complex aneuploid results. In the second cycle, frozen sperm from PESA was used. Three eggs were inseminated on the day of the procedure (resulting in 2 blastocysts), and three in vitro matured eggs were inseminated after 24 hours (resulting in 1 blastocyst). NGS analysis showed two complex aneuploid embryos and one 40% low-level trisomy 20 aneuploid mosaicism (+20) for the post 24-hour embryo. A mosaic embryo transfer was performed, resulting in clinical pregnancy and birth of a healthy baby girl with a normal blood karyotype.
DISCUSSION
Mosaic embryo transfer is a topic for discussion. Certain levels of mosaicism do not seem to pose risks to the development of the fetus.
Topics: Pregnancy; Male; Humans; Female; Semen; Embryo Transfer; Fertilization in Vitro; Sperm Injections, Intracytoplasmic; Aneuploidy; Blastocyst
PubMed: 38381775
DOI: 10.5935/1518-0557.20230055 -
International Journal of Molecular... Jan 2024The increasing incidence of male infertility in humans and animals creates the need to search for new factors that significantly affect the course of reproductive...
The increasing incidence of male infertility in humans and animals creates the need to search for new factors that significantly affect the course of reproductive processes. Therefore, the aim of this study was to determine the temporospatial expression of aquaglyceroporins (AQP3, AQP7 and AQP9) in the bovine () reproductive system using immunohistochemistry and Western blotting. The study also included morphological analysis and identification of GATA-4. In brief, in immature individuals, AQP3 and AQP7 were found in gonocytes. In reproductive bulls, AQP3 was observed in spermatocytes and spermatogonia, while AQP7 was visible in all germ cells and the Sertoli cells. AQP7 and AQP9 were detected in the Leydig cells. Along the entire epididymis of reproductive bulls, aquaglyceroporins were visible, among others, in basal cells (AQP3 and AQP7), in epididymal sperm (AQP7) and in the stereocilia of the principal cells (AQP9). In males of all ages, aquaglyceroporins were identified in the principal and basal cells of the vas deferens. An increase in the expression of AQP3 in the testis and cauda epididymis and a decrease in the abundance of AQP7 in the vas deferens with age were found. In conclusion, age-related changes in the expression and/or distribution patterns of AQP3, AQP7 and AQP9 indicate the involvement of these proteins in the normal development and course of male reproductive processes in cattle.
Topics: Humans; Cattle; Male; Animals; Aquaporin 3; Aquaporins; Semen; Epididymis; Aquaglyceroporins
PubMed: 38338845
DOI: 10.3390/ijms25031567 -
Frontiers in Pediatrics 2024Zinner syndrome (ZS) is the association of seminal vesicle cysts, ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. This condition is very rare...
INTRODUCTION
Zinner syndrome (ZS) is the association of seminal vesicle cysts, ipsilateral ejaculatory duct obstruction, and ipsilateral renal agenesis. This condition is very rare in children and both diagnosis and treatment may be challenging. We reviewed the clinical presentation and treatment describing our experience with a series of three patients.
METHODS
From January 2016 to January 2021, three patients (patients 1, 2, and 3) with symptomatic ZS, aged 2, 15, and 17 years, respectively, were diagnosed and treated. All three patients were symptomatic, manifesting pelvic pain and dysuria. The diagnosis was made by physical examination, ultrasonography, and abdominopelvic MRI. Patient 1 underwent open surgery, while for patients 2 and 3, laparoscopic excision was performed.
RESULTS
The renal agenesis regarded the left side in patients 1 and 3, and the right side in patient 2. In all cases, the cystic complex was excised. The mean operating time was 4 h and the mean hospitalization time was 5 days (range 4-6 days). The mean follow-up period was 5 years (range 2-5 years). Patients 1 and 3 showed a complete resolution of the symptoms during postoperative follow-up. In patient 2, clinical symptoms relapsed because of the persistence of a 9 mm cyst requiring a redo laparoscopic excision.
CONCLUSIONS
Seminal vesicle cyst with ipsilateral renal agenesis, even if rare in pediatric age, should be suspected in young male patients presenting with pelvic cystic masses, pelvic pain, dysuria, and ipsilateral renal absence. Conservative management should be reversed to asymptomatic patients. Surgical treatment is mandatory in symptomatic cases and the preferred approach is minimally invasive surgery to magnify the operating field to spare anatomical structures, primarily the contralateral vas deferens. Radicality is crucial to avoid the persistence of symptoms and the need for reintervention.
PubMed: 38328345
DOI: 10.3389/fped.2024.1353960 -
PloS One 2024This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE... (Meta-Analysis)
Meta-Analysis
Comparative evaluation of double- and single-armed two-suture longitudinal intussusception techniques in microsurgical vasoepididymostomy: An updated systematic review and meta-analysis.
BACKGROUND
This study aimed to compare the outcomes of double-armed two-suture longitudinal intussusception microsurgical vasoepididymostomy (LIVE) and single-armed two-suture LIVE techniques in patients with epididymal obstructive azoospermia (EOA). The main outcomes assessed were patency rates, patency time, semen quality and natural pregnancy rates.
METHODS
Data from patients with EOA who underwent two-suture LIVE were obtained from databases including PubMed, EMBASE, and Web of Science. Weighted data were analyzed using a random-effects model, and weighted mean differences were reported.
RESULTS
A total of 1574 patients with EOA from 24 studies were included. The overall patency rate was approximately 68% (95% confidence interval [CI]: 63-72%), with a patency time of approximately 4.63 months (95% CI: 4.15-5.12). The sperm concentration reached 26.90 million/ml and the sperm motility was 23.74%. The natural pregnancy rate was 38% (95% CI: 31-46%). The different definitions of patency do not seem to have any meaningful impact when comparing patency rates. There was no significant difference in patency rates, patency time, semen quality and natural pregnancy rates between the double-armed and single-armed LIVE techniques.
CONCLUSION
The single-armed LIVE is a potential alternative surgical option when high quality double-needle sutures are not easily accessible.
Topics: Pregnancy; Female; Humans; Male; Semen Analysis; Intussusception; Treatment Outcome; Sperm Motility; Microsurgery; Semen; Epididymis; Azoospermia; Sutures; Vas Deferens
PubMed: 38315686
DOI: 10.1371/journal.pone.0298019 -
Journal of Minimal Access Surgery Jan 2024This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in...
INTRODUCTION
This study aimed to investigate the feasibility of applying laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia in children.
PATIENTS AND METHODS
From December 2017 to November 2018, we recruited 20 children, who were aged 1-6 years old, with indirect inguinal hernia. At the time of admission, the participants had already developed an indirect inguinal hernia for 6 months to 1 year. A simple transection and partial resection of hernia sac was performed at the internal ring on each of the recruited children. The procedure was conducted under laparoscopy. Two 5-mm trocars were placed on either side of the umbilicus, one for the camera and the other for a surgical instrument. Another trocar was placed on the right abdomen. Laparoscopic camera curved forceps, and scissors were placed. Along the unclosed internal ring, the peritoneum was cut in a circular fashion to transect the hernia sac and dissociate it from the distal end. About 1-2 cm of the hernia sac was resected.
RESULTS
The operation was successfully completed in all 20 cases, who did not experience any complications, such as the absence of spermatic cord, vas deferens injury, scrotal swelling and incision infection. The children were discharged 1 day after the operation. In the post-operative follow-up for the first 3-4 years, recurrence and testicular atrophy did not occur in the study participants.
CONCLUSION
The short-term results obtained from this study showed that the application of laparoscopic transection and partial resection of hernia sac in the treatment of indirect inguinal hernia is feasible. Long-term results and further observation are needed for validation.
PubMed: 38289023
DOI: 10.4103/jmas.jmas_78_23 -
Cureus Dec 2023Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic...
Inflammation of the vas deferens, or vasitis, is a rarely reported condition that can manifest as either acutely painful infectious vasitis or predominantly asymptomatic vasitis nodosa. Acute vasitis is usually presented with ambiguous clinical findings, and a scan is required for a definitive diagnosis. Retrograde urinary pathogens are typically the cause, and it is treatable conservatively. We present a male in his 40s with a one-day history of right groin pain and a history of right indirect inguinal hernia. On examination, there was an impression of an incarcerated inguinal hernia. A CT scan revealed thickening and inflammatory changes associated with the inguinal canal and a picture of the rare inflammatory condition, acute vasitis. This case report illustrates the significance of understanding the wide range of possible diagnoses associated with acute groin pain and swelling and the importance of imaging in the diagnosis, which might help avoid needless operation.
PubMed: 38288181
DOI: 10.7759/cureus.51337