Creation of synthetic contrast-enhanced computed tomography images using deep neural networks to screen for renal cell carcinoma.

In this study, we elucidate if synthetic contrast enhanced computed tomography images created from plain computed tomography images using deep neural networks could be used for screening, clinical diagnosis, and postoperative follow-up of small-diameter renal tumors. This retrospective, multicenter study included 155 patients (artificial intelligence training cohort [n = 99], validation cohort [n = 56]) who underwent surgery for small-diameter (≤40 mm) renal tumors, with the pathological diagnosis of renal cell carcinoma, during 2010-2020. We created a learned deep neural networks using pix2pix. We examined the quality of the synthetic enhanced computed tomography images created using this deep neural networks and compared them with real enhanced computed tomography images using the zero-mean normalized cross-correlation parameter. We assessed concordance rates between real and synthetic images and diagnoses according to 10 urologists by creating a receiver operating characteristic curve and calculating the area under the curve. The synthetic computed tomography images were highly concordant with the real computed tomography images, regardless of the existence or morphology of the renal tumor. Regarding the concordance rate, a greater area under the curve was obtained with synthetic computed tomography (area under the curve = 0.892) than with only computed tomography (area under the curve = 0.720; p < 0.001). In conclusions, this study is the first to use deep neural networks to create a high-quality synthetic computed tomography image that was highly concordant with a real computed tomography image. Our synthetic computed tomography images could be used for urological diagnoses and clinical screening.

[A CASE OF VAGINAL MESH EXPOSURE DIAGNOSED 15 YEARS AFTER TVT SURGERY FOR STRESS URINARY INCONTINENCE].

Midurethral sling procedures are regarded as standard therapies to treat female stress urinary incontinence. However, informed consent must be gained from the patients concerning the possibility of mesh complications. Furthermore, understanding of these complications is required by medical practitioners in general. A 59-year-old postmenopausal woman had undergone TVT surgery to treat stress urinary incontinence in our department 15 years ago. Due to genital bleeding which started 10 years later, she visited a gynecologist in another hospital and was referred to us due to vaginal erosion. During the pelvic examination, a cord-like structure was palpable on the right side of the anterior vaginal wall. Upon inspection of the vagina using a cystoscope, the foreign body attached to the anterior vaginal wall was clearly visible. After the diagnosis of vaginal mesh exposure, she underwent a transvaginal partial resection of the TVT tape. She had no recurrence of mesh exposure or stress urinary incontinence in a 6-month follow-up. Although infrequently reported in Japanese literature, medical practitioners must be cautious of mesh exposure that can occur long after midurethral sling procedures.

Post-bath incontinence (bathwater incontinence) can be managed with behavioral therapy.

Introduction: We encountered six post-bath incontinence cases caused by bathwater entrapment in the vagina. Case presentation: The age of onset was distributed from 16 to 78 (average 38) and five out of six patients were parous. Three patients developed post-bath incontinence immediately after vaginal delivery. One patient developed post-bath incontinence after beginning to bathe in a reclined position and another after undergoing transvaginal mesh surgery to treat prolapse. All patients showed dribbling incontinence without urgency limited to within 30 min after bathing. Patients were instructed to put a towel between their legs and apply abdominal pressure to evacuate the entrapped water. Additionally, they were advised to squat in the bathtub to prevent water entrapment. This simple behavioral therapy relieved symptoms. Conclusion: The differential diagnosis of incontinence in women should include entrapped fluid incontinence such as bathwater incontinence, pool water incontinence, and vaginal reflux during micturition.