1
|
Bakker AFHA, de Nijs JV, Jaspers TJM, de With PHN, Beulens AJW, van der Poel HG, van der Sommen F, Brinkman WM. Estimating Surgical Urethral Length on Intraoperative Robot-Assisted Prostatectomy Images Using Artificial Intelligence Anatomy Recognition. J Endourol 2024; 38:690-696. [PMID: 38613819 DOI: 10.1089/end.2023.0697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
Objective: To construct a convolutional neural network (CNN) model that can recognize and delineate anatomic structures on intraoperative video frames of robot-assisted radical prostatectomy (RARP) and to use these annotations to predict the surgical urethral length (SUL). Background: Urethral dissection during RARP impacts patient urinary incontinence (UI) outcomes, and requires extensive training. Large differences exist between incontinence outcomes of different urologists and hospitals. Also, surgeon experience and education are critical toward optimal outcomes. Therefore, new approaches are warranted. SUL is associated with UI. Artificial intelligence (AI) surgical image segmentation using a CNN could automate SUL estimation and contribute toward future AI-assisted RARP and surgeon guidance. Methods: Eighty-eight intraoperative RARP videos between June 2009 and September 2014 were collected from a single center. Two hundred sixty-four frames were annotated according to prostate, urethra, ligated plexus, and catheter. Thirty annotated images from different RARP videos were used as a test data set. The dice (similarity) coefficient (DSC) and 95th percentile Hausdorff distance (Hd95) were used to determine model performance. SUL was calculated using the catheter as a reference. Results: The DSC of the best performing model were 0.735 and 0.755 for the catheter and urethra classes, respectively, with a Hd95 of 29.27 and 72.62, respectively. The model performed moderately on the ligated plexus and prostate. The predicted SUL showed a mean difference of 0.64 to 1.86 mm difference vs human annotators, but with significant deviation (standard deviation = 3.28-3.56). Conclusion: This study shows that an AI image segmentation model can predict vital structures during RARP urethral dissection with moderate to fair accuracy. SUL estimation derived from it showed large deviations and outliers when compared with human annotators, but with a small mean difference (<2 mm). This is a promising development for further research on AI-assisted RARP.
Collapse
Affiliation(s)
- Aron F H A Bakker
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joris V de Nijs
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tim J M Jaspers
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter H N de With
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Alexander J W Beulens
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk G van der Poel
- Department of Oncological Urology, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fons van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willem M Brinkman
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
2
|
Burger M. Re: First-in-human Evaluation of a Prostate-specific Membrane Antigen-targeted Near-infrared Fluorescent Small Molecule for Fluorescence-based Identification of Prostate Cancer in Patients with High-risk Prostate Cancer Undergoing Robotic-assisted Prostatectomy. Eur Urol 2024; 85:588-589. [PMID: 38521614 DOI: 10.1016/j.eururo.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Maximilian Burger
- Department of Urology, Caritas-St. Josef Medical Center, University of Regensburg, Regensburg, Germany.
| |
Collapse
|
3
|
Baas DJH, Reitsma J, van Gerwen L, Vleghaar J, Gehlen JMLG, Ziedses des Plantes CMP, van Basten JPA, van den Bergh RCN, Bruins HM, Collette ERP, Hoekstra RJ, Knipscheer BC, van Leeuwen PJ, Luijendijk-de Bruin D, van Roermund JGH, Sedelaar JPM, Speel TGW, Stomps SP, Wijburg CJ, Wijn RPWF, de Jong IJ, Somford DM. Validation of Claims Data for Absorbing Pads as a Measure for Urinary Incontinence after Radical Prostatectomy, a National Cross-Sectional Analysis. Cancers (Basel) 2023; 15:5740. [PMID: 38136286 PMCID: PMC10742264 DOI: 10.3390/cancers15245740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The use of healthcare insurance claims data for urinary incontinence (UI) pads has the potential to serve as an objective measure for assessing post-radical prostatectomy UI rates, but its validity for this purpose has not been established. The aim of this study is to correlate claims data with Patient Reported Outcome Measures (PROMs) for UI pad use. Patients who underwent RP in the Netherlands between September 2019 and February 2020 were included. Incontinence was defined as the daily use of ≥1 pad(s). Claims data for UI pads at 12-15 months after RP were extracted from a nationwide healthcare insurance database in the Netherlands. Participating hospitals provided PROMS data. In total, 1624 patients underwent RP. Corresponding data of 845 patients was provided by nine participating hospitals, of which 416 patients were matched with complete PROMs data. Claims data and PROMs showed 31% and 45% post-RP UI (≥1 pads). UI according to claims data compared with PROMs had a sensitivity of 62%, specificity of 96%, PPV of 92%, NPV of 75% and accuracy of 81%. The agreement between both methods was moderate (κ = 0.60). Claims data for pads moderately align with PROMs in assessing post-prostatectomy urinary incontinence and could be considered as a conservative quality indicator.
Collapse
Affiliation(s)
- Diederik J. H. Baas
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
| | - Jan Reitsma
- Zorgverzekeraars Nederland, 3700 AM Zeist, The Netherlands
| | | | - Jaron Vleghaar
- Vektis Intelligence, Vektis, 3700 AS Zeist, The Netherlands
| | | | | | - Jean Paul A. van Basten
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
| | | | - H. Max Bruins
- Department of Urology, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | | | - Robert J. Hoekstra
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
- Department of Urology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
| | - Ben C. Knipscheer
- Department of Urology, Treant Zorggroep, 7824 AA Emmen, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands
| | | | - Joep G. H. van Roermund
- Department of Urology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - J. P. Michiel Sedelaar
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Tommy G. W. Speel
- Department of Urology, Leeuwarden Medical Center, 8934 AD Leeuwarden, The Netherlands
| | - Saskia P. Stomps
- Department of Urology, Ziekenhuisgroep Twente, 7609 PP Almelo, The Netherlands
| | - Carl J. Wijburg
- Department of Urology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| | - Rob P. W. F. Wijn
- Department of Urology, Jeroen Bosch Hospital, 5223 GZ Hertogenbosch, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Diederik M. Somford
- Department of Urology, Canisius Wilhelmina Hospital, 6532 SZ Nijmegen, The Netherlands
- Prosper Prostate Cancer Clinics, 6532 SZ Nijmegen, The Netherlands
| |
Collapse
|