Female detrusor underactivity: Two uterine leiomyoma cases.

INTRODUCTION: Female urinary retention is rare. CASE PRESENTATION: Case 1, a 35-year-old nulliparous woman, and case 2, a 47-year-old nulliparous woman, had transient urinary retention. A urodynamics revealed increased bladder sensation in case 1 and detrusor underactivity with a large post-void residual in cases 1 and 2. Both women had a uterine leiomyoma of >10 cm in diameter. Soon after extraction of the tumor, retention episodes disappeared completely in case 1. CONCLUSION: Although rare, uterine leiomyoma should be listed as a cause of female detrusor underactivity.

Computer vision for total laparoscopic hysterectomy.

INTRODUCTION: Laparoscopic surgery is widely performed in various surgical fields, but this technique requires time for surgeons to master. However, at the same time, there are many advantages in visualizing the operative field through a camera. In other words, we can visualize what we cannot see with our own eyes by using augmented reality and computer vision. Therefore, we investigated the possibilities and usefulness of computer vision in total laparoscopic hysterectomy. METHODS: This study was approved by the Mitsui Memorial Hospital ethics committee. Patients who underwent total laparoscopic hysterectomy at Mitsui Memorial Hospital from January 2015 to December 2015 were enrolled. We evaluated 19 cases in which total laparoscopic hysterectomy was performed by the same operator and assistant. We used the Open Source Computer Vision Library for computer vision analysis. The development platform used in this study was a computer operating on Mac OS X 10.11.3. RESULTS: We created panoramic images by matching features with the AKAZE algorithm. Noise reduction methods improved haziness caused by using energy devices. By abstracting the color of the suture string, we succeeded in abstracting the suture string from movies. We could not achieve satisfactory results in detecting ureters, and we expect that creative ideas for ureter detection may arise from collaborations between surgeons and medical engineers. CONCLUSIONS: Although this was a preliminary study, the results suggest the utility of computer vision in assisting laparoscopic surgery.

Retained Barium in the Appendix Is Difficult to Distinguish from Surgical Remnants following Laparoscopic Surgery.

Surgical materials, such as gauze, can be accidentally left inside of patients following surgery. This iatrogenic complication should be avoided and is often prevented by routine X-ray analysis after surgical abdominal procedures. We report a case of retained barium in the appendix that was difficult to distinguish from surgical remnants. A 41-year-old Japanese female was diagnosed with uterine leiomyoma and underwent laparoscopic myomectomy. The postoperative X-ray test showed a cord-like material in the lower right abdomen that was not captured in the preoperative X-ray test two months prior to the operation. Because of this difference, the area was reexamined laparoscopically. After examination, we concluded that the cord-like material in X-ray tests was in fact retained barium in the appendix. Barium can be retained in the appendix for long periods of time, and retained barium in the appendix can be captured radiographically and can mimic the appearance of surgical remnants, appearing as a cord-like material. The knowledge above combined with detailed interviews before surgery could prevent such confusion during interpretation of X-ray tests after surgery.

Exploration of assistive technology for uniform laparoscopic surgery.

INTRODUCTION: Laparoscopic surgery is less invasive than open surgery and is now common in various medical fields. However, laparoscopic surgery is more difficult than open surgery and often requires additional time for the operator to achieve mastery. Therefore, we investigated the use of assistive technology for uniform laparoscopic surgery. METHODS: We used the OpenCV2 library for augmented reality with an ArUco marker to detect and estimate forceps positioning. We used Sense HAT as the gyro sensor. The development platforms used were Mac OS X 10.11.3 and Raspberry Pi 3, model B. RESULTS: By attaching the ArUco marker to the needle holder, we could draw a line vertically to the marker. When the needle was held, a cube could be imagined, and both the needle and lines could be used to determine the appropriate position. By attaching the gyro sensor to the camera, we could detect its angle of rotation. We obtained stabilized images by rotating the image by the detected degrees; this was possible for any camera position. CONCLUSIONS: Assistive technology allowed us to obtain consecutive converted images in real time and may be readily applicable to clinical practice.

Gynecologists May Underestimate the Amount of Blood Loss during Total Laparoscopic Hysterectomy.

BACKGROUND: We considered the possibility of underestimation of the amount of bleeding during laparoscopic surgery, and we investigated comparing the amount of bleeding between laparoscopic surgery and open surgery by considering the concentration of hemoglobin before and after surgery as indicators. METHODS: The following procedures were included: A, surgery for ovarian tumor; B, myomectomy; and C, hysterectomy either by laparoscopic surgery or open surgery. Patients who underwent the above procedures in between January 1, 2010, and December 31, 2017, were enrolled. We identified 1749 cases (A: 90, B: 105, and C: 325 of open surgery and A: 667, B: 437, and C: 125 of laparoscopic surgery). We considered the sum as an estimation of blood loss during surgery and the change in the value of hemoglobin in laboratory testing one day before and after surgery. RESULTS: During laparoscopic surgery, the measurements of blood loss included the following: A: 59.8 ml; B: 168.6 ml; and C: 206.8 ml. During open surgery, measurements of blood loss included the following: A: 130.7 ml; B: 236.7 ml; and C; 280.9 ml. The reduction of hemoglobin after surgery compared with that before surgery was less in laparoscopic surgery than that in open surgery in A and B; however, this reduction was not significantly different in C. CONCLUSION: Our results suggest that the estimation of the bleeding in A and B was appropriate; however, the estimation might be underestimated in C during laparoscopic surgery.

Reliability and validity of the Japanese version of the pelvic floor distress inventory-short form 20.

INTRODUCTION AND HYPOTHESIS: The aim of this study was to translate the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) into Japanese and test its reliability and validity among Japanese women. METHODS: Fifty-nine women with and without pelvic floor disorders (age 55.8 ± 16.8 years, mean ± SD) completed the Japanese PFDI-20 (J-PFDI-20) questionnaire at baseline and 2 weeks later. Intraclass correlation coefficients (ICC) and the Bland and Altman method for test-retest reliability and Cronbach's alpha for internal consistency of the J-PFDI-20 were used. Scores of total and subscales were compared between women with and without pelvic floor disorders for known-groups validity. Spearman's correlation coefficients between the J-PFDI-20 and the severity of pelvic floor disorders and Urinary Incontinence Quality of Life Scale (I-QOL) were used for construct validity. RESULTS: The PFDI-20 was successfully translated from English into Japanese with face validity through rigorous cross-cultural validation. Test-retest reliability of the J-PFDI-20 and three subscales was good to excellent (ICC=0.77-0.90). The Bland and Altman analysis showed that differences between the first and second scores of total J-PFDI-20 and its subscales were not significantly different from 0 and largely fell within the range of 0 ± 1.96 SD. Cronbach's alpha values were 0.52-0.83. Analysis of known-groups validity showed differences in scores of the J-PFDI-20 between women with and without pelvic floor disorders. Acceptable construct validity was found in J-PFDI-20 total and subscale scores with positive correlations to severity of pelvic floor disorders (ρ>0.35) and negative correlations to I-QOL (ρ<-0.39). CONCLUSIONS: The results suggest that the J-PFDI-20 is a reliable and valid condition-specific quality of life instrument for women with pelvic floor disorders.

Anti-Toxoplasma antibody prevalence, primary infection rate, and risk factors in a study of toxoplasmosis in 4,466 pregnant women in Japan.

Toxoplasmosis is a zoonosis caused by infection with Toxoplasma gondii and is prevalent worldwide under various climatic conditions. It is usually asymptomatic, but infection in pregnant women can pose serious health problems for the fetus. However, epidemiological information regarding toxoplasmosis in Japanese pregnant women is limited. This study aimed to determine the prevalence of anti-Toxoplasma antibodies, the primary infection rate, and the risk factors for toxoplasmosis in Japanese pregnant women. We measured anti-Toxoplasma antibody titers in 4,466 pregnant women over a period of 7.5 years and simultaneously conducted interviews to identify the risk factors for toxoplasmosis. The overall prevalence of anti-Toxoplasma antibodies was 10.3%, and it was significantly higher in women aged above 35 years. The rate of primary Toxoplasma infection during pregnancy was estimated to be 0.25%. A possibility of infection in the later stages of pregnancy was identified for those women who were not infected in the early stages. A history of raw meat intake was identified to be a risk factor related to toxoplasmosis. Therefore, to lower the risk of toxoplasmosis, pregnant women should refrain from eating raw and undercooked meat and maintain personal hygiene.

Evaluation of pelvic floor function by transabdominal ultrasound in postpartum women.

PURPOSE: To investigate the relationship between displacement of the bladder base and genitohiatal distance during voluntary contractions of pelvic floor muscles in postpartum women. METHODS: Twenty women (age 34.7 ± 4.4 years, BMI 21.1 ± 3.2 kg/m(2)) at about 6 weeks after a vaginal delivery were studied. Displacement of the bladder base and genitohiatal distance were measured by transabdominal and transperineal ultrasound, respectively. RESULTS: Displacement of the bladder base was significantly correlated with shortening of genitohiatal distance (r = 0.772, p < 0.001). The intraclass correlation coefficient of the three measurements in each woman was 0.796 for displacement of the bladder base. There was no significant difference in terms of displacement of the bladder base between continent women and incontinent women. CONCLUSION: This study suggests a strong positive correlation between displacement of the bladder base and shortening of genitohiatal distance during voluntary contractions of pelvic floor muscles in postpartum women. Measurement of displacement of the bladder base by transabdominal ultrasound can be helpful for evaluating pelvic floor function in postpartum women.

[Medical treatment for female pelvic floor dysfunction and prospective role of urologists].

With declining birthrate and graying of population, the significance of female pelvic floor dysfunction (FPFD) and importance of its medical treatment are being emphasized in developed nations. In our country, more and more urological departments have started working on FPFD in the past several years. Compared to the past times when only gynecologists treated pelvic organ prolapse, now pelvic support problems and its inherent lower urinary tract dysfunction are treated simultaneously in a better way by urologists' participation. The urological approach has added compound eyes to pelvic relaxation disorders. Further effort is expected to help develop novel technology in the treatment of stress urinary incontinence. Although it is certain that female pelvic floor medicine is beneficial to our society, its possibility and limitation remain to be studied.

Tension-free vaginal tape surgery for stress urinary incontinencne: a prospective multicentered study in Japan.

AIM: To report the prospective multicentered study of the tension-free vaginal tape (TVT) procedure for stress urinary incontinence. METHODS: One hundred and fifty-one women with stress urinary incontinence were operated on by the TVT procedure and were followed up at 3, 12, and 24 months after surgery. Patients' age and body mass index (BMI) averaged 57 years and 23.9, respectively. Forty-nine women were classified as type I, 46 women type II and 56 women type III (McGuire's classification). Local anesthesia was used in the operations on 137 women (91%) and epidural or general anesthesia was used in 14 (9%). Surgical outcomes were analyzed with Kaplan-Meier survival curves. RESULTS: The subjective and objective cumulative cure rates 24 months later were 92% and 77%, respectively (P > 0.05). The TVT operation for women with type III (62%) resulted in a significantly lower cure rate compared to those with type I or with type II (83%) (P < 0.001). Post-operatively a urethral catheter was indwelt one day in 77 women (51%), two days in 14 (9%) and 3-7 days in 60 (40%). Surgical complications were encountered in 43 women (28%). The most frequent was bladder perforation in 24 women followed by postoperative difficulty in urination and de novo urgency. CONCLUSIONS: The TVT surgery was promising for the treatment of stress incontinence because of minimal surgical invasiveness and satisfactory surgical results. Women with type III incontinence resulted in fewer satisfactory outcomes than those with type I or II incontinence.

Quality of life assessments in women operated on by tension-free vaginal tape (TVT).

The aim of the study was to evaluate quality of life (QOL) prospectively in women who undergo tension-free vaginal tape (TVT) operation for stress urinary incontinence. Sixty-six women who completed QOL questionnaires and a 2-year follow-up examination were included. Improvement of health-related QOL was assessed by the Incontinence Impact Questionnaire-7 (IIQ-7), the Urogenital Distress Inventory-6 (UDI-6), and two questions regarding patient satisfaction and de novo urge incontinence. Prior to surgery, patients complained most of stress symptoms followed by physical activities and emotional health. Postoperatively IIQ-7 and UDI-6 as a whole and all seven domains improved significantly (p<0.001). Scores of IIQ-7, UDI-6, and seven domains did not differ between the adult and the elderly groups. Of the patients 88% were much satisfied or satisfied with surgical outcomes. Incidence of de novo urge incontinence was 12%. It is concluded that the TVT procedure significantly improved health-related quality of life.

Input and output characteristics of collision avoidance behavior in the frog Rana catesbeiana.

Input and output characteristics of collision avoidance behavior in the bullfrog were examined using computer graphics to model a looming stimulus. The means of time-to-collision of avoidance behavior in response to looming visual stimuli approaching at a velocity of either 2 or 4 m/s were significantly different (t141) = 7.93, p < 0.05). On the other hand, mean threshold sizes of visual stimuli triggering avoidance behavior were not significantly different in either case (t201) = 0.54, p > 0.05). Furthermore, we showed that the mean threshold sizes changed in a predictable manner depending on the distance between the displayed stimulus and the animal. These results strongly suggest that the frog displays collision avoidance behavior when the visual angle of a looming object reaches a constant value (about 20 degrees ). The mean maximum velocities of the avoidance behavior in response to the two visual stimuli were not significantly different (t198) = 1.44, p > 0.05). However, we found that the frog could control the velocity depending on the location of an approaching object in its dorsal visual field. Finally, we demonstrated that habituation significantly affected the mean probability of avoidance behavior occurrence (ANOVA, at 2 m/s, F(2,15) = 14.25; at 4 m/s, F(2,15) = 13.35, p < 0.05), but not those of time-to-collision, threshold size and maximum velocity (ANOVA, at 2 m/s, F(2,13) = 0.07, F(2,14) = 0.46 and F(2,14) = 0.70, respectively; at 4 m/s, F(2,15) = 0.50, F(2,14) = 0.68 and F(2,14) = 0.41, respectively, p > 0.05). Thus, frog collision avoidance behavior seems to have an all or none-like property.