Optimizing anterior urethral stricture assessment: leveraging AI-assisted three-dimensional sonourethrography in clinical practice.

PURPOSE: This investigation sought to validate the clinical precision and practical applicability of AI-enhanced three-dimensional sonographic imaging for the identification of anterior urethral stricture. METHODS: The study enrolled 63 male patients with diagnosed anterior urethral strictures alongside 10 healthy volunteers to serve as controls. The imaging protocol utilized a high-frequency 3D ultrasound system combined with a linear stepper motor, which enabled precise and rapid image acquisition. For image analysis, an advanced AI-based segmentation process using a modified U-net algorithm was implemented to perform real-time, high-resolution segmentation and three-dimensional reconstruction of the urethra. A comparative analysis was performed against the surgically measured stricture lengths. Spearman's correlation analysis was executed to assess the findings. RESULTS: The AI model completed the entire processing sequence, encompassing recognition, segmentation, and reconstruction, within approximately 5 min. The mean intraoperative length of urethral stricture was determined to be 14.4 ± 8.4 mm. Notably, the mean lengths of the urethral strictures reconstructed by manual and AI models were 13.1 ± 7.5 mm and 13.4 ± 7.2 mm, respectively. Interestingly, no statistically significant disparity in urethral stricture length between manually reconstructed and AI-reconstructed images was observed. Spearman's correlation analysis underscored a more robust association of AI-reconstructed images with intraoperative urethral stricture length than manually reconstructed 3D images (0.870 vs. 0.820). Furthermore, AI-reconstructed images provided detailed views of the corpus spongiosum fibrosis from multiple perspectives. CONCLUSIONS: The research heralds the inception of an innovative, efficient AI-driven sonographic approach for three-dimensional visualization of urethral strictures, substantiating its viability and superiority in clinical application.

Clinical application values of a novel synthetic training simulator for bulbar urethral anastomosis.

Purpose: This study aimed to report a newly developed, high-fidelity synthetic simulator to simulate excision and primary anastomotic (EPA) bulbar urethroplasty and its clinical use for new practitioners in shortening the learning curve. Material and Methods: The bulbar urethral anastomosis simulator consists of several standardized components created according to the actual size of the male patient. Interns, novice residents, and fellows inexperienced with urethral reconstruction (n = 10, 5, 5) from different medical centres were invited to participate in the training programme. Two reconstructive urology experts monitored each practice. Following the training, three kinds of validity testing were used to assess the simulator: face, content, and construct. In the intern group, the task performance in the first five training sessions and the last five training ones were compared using a self-control approach. In the resident and fellow group, the real surgical data, including estimated blood loss, operative duration, and 6-month post-operative success rate of trainees after training, are plotted, which are compared with that of reconstructive urology experts (n = 5) included retrospectively to study the effectiveness of the simulator in shortening the learning curve. Results: The overall mean satisfaction rate for the simulators was inspiring and evaluated by experts. In the intern group, significant improvement can be achieved through 10 training sessions (p < 0.05). In clinical practice, the intraoperative indicators and surgical success rate of both the training groups showed the tendency to close or even better than those in the expert group. In terms of the learning curve, training groups performed better compared with experts in the early stages of their careers. Conclusions: In conclusion, this synthetic training simulator for bulbar urethral anastomosis is novel, effective, and convenient for beginners of different groups. The training course can bridge the gap between preclinical use and actual surgery via this simulator.

Surgical treatment of pelvic fracture urethral distraction defects in boys: which approach is suitable?

Pelvic fracture urethral distraction defects (PFUDDs) are relatively infrequent in boys, and treatment for PFUDDs presents one of the most difficult problems in urological practice. Anastomotic urethroplasty is considered an ideal surgical procedure for PFUDDs in boys. However, various surgical approaches for anastomotic urethroplasty have been proposed, including a simple transperineal approach, a transperineal intercorporal septal separation approach, a transperineal inferior pubic approach, and a combined transpubic-perineal approach. This study aims to determine which surgical approach is best for PFUDDs in boys. We retrospectively identified 22 boys with PFUDDs aged 2-14 years who underwent anastomotic urethroplasty via different approaches between January 2008 and December 2017. Follow-up was performed in all the 22 patients for 6-123 (mean: 52.0) months. Finally, 20 of the 22 boys (90.9%) were successfully treated, including 1 of 2 patients treated with a simple transperineal approach, 3 of 3 with a transperineal approach with intercorporal septal separation, 14 of 15 with a transperineal inferior pubic approach, and 2 of 2 with a combined transpubic-perineal approach. Two patients had failed outcomes after the operation, and stenosis recurred. Based on the outcome of the 22 patients, we can draw a preliminary conclusion that most boys (20/22) can be treated with a transperineal inferior pubic approach or simpler procedures without the need of completely removing or incising the pubis. The combined transpubic-perineal approach can be used in cases of extremely long urethral distract defects.

Laparoscopic T-Plasty for the Treatment of Refractory Bladder Neck Stenosis.

Preliminary results of a case series on refractory bladder neck stenosis treated with laparoscopic T-plasty are presented in this article. This study retrospectively identified nine patients with refractory bladder neck stenosis aged 60 to 80 years between May 2016 and December 2017, who had undergone laparoscopic T-plasty. All patients presented voiding difficulty and failed after two or more prior endoscopic treatments. Laparoscopic T-plasty was performed by incising the anterior wall of the bladder neck in a T-shaped manner and creating two well-vascularized and tension-free flaps, which offer the possibility to reconstruct a wide bladder neck. After a mean follow-up of 14.7 months (ranging 3-22 months), a successful outcome was achieved in eight patients without incontinence secondary to surgery. Recurrent voiding difficulty developed in one patient, which was cured after a following endoscopic treatment. Through these nine patients, a preliminary conclusion can be drawn that a wider bladder neck can be obtained through modified YV-reconstruction of the bladder neck, while avoiding external urethral sphincter injury. And laparoscopic T-plasty has clear advantages compared with an open approach. It is an available and effective option for refractory bladder neck stenosis.

Penoscrotal Transposition to Achieve Urethral Continuity After Long-Segment Urethral Defect: A Case Report.

Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty for the treatment of long-segment bulbar and membranous urethral stenosis is rarely reported. This study reports the case of a 43-year-old man with dysuria resulting from pelvic fracture. The patient had a long-term history of multiple urethral reconstructions and presented a long-segment bulbar and membranous urethral stenosis at imaging. Penoscrotal transposition and pendulous-prostatic anastomotic urethroplasty was performed and completed in 170 min (blood loss: 400 ml). Postoperative treatment was uneventful with favorable short-term outcomes and high patient satisfaction without recurrence at 12-month follow-up. This surgical technique should be attempted in carefully selected patients with long-segment bulbar and membranous urethral stenosis and performed by an experienced urethral reconstruction specialist.