1
|
Anastasiadis A, Koudonas A, Langas G, Tsiakaras S, Memmos D, Mykoniatis I, Symeonidis EN, Tsiptsios D, Savvides E, Vakalopoulos I, Dimitriadis G, de la Rosette J. Transforming urinary stone disease management by artificial intelligence-based methods: A comprehensive review. Asian J Urol 2023; 10:258-274. [PMID: 37538159 PMCID: PMC10394286 DOI: 10.1016/j.ajur.2023.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/23/2022] [Accepted: 02/10/2023] [Indexed: 08/05/2023] Open
Abstract
Objective To provide a comprehensive review on the existing research and evidence regarding artificial intelligence (AI) applications in the assessment and management of urinary stone disease. Methods A comprehensive literature review was performed using PubMed, Scopus, and Google Scholar databases to identify publications about innovative concepts or supporting applications of AI in the improvement of every medical procedure relating to stone disease. The terms ''endourology'', ''artificial intelligence'', ''machine learning'', and ''urolithiasis'' were used for searching eligible reports, while review articles, articles referring to automated procedures without AI application, and editorial comments were excluded from the final set of publications. The search was conducted from January 2000 to September 2023 and included manuscripts in the English language. Results A total of 69 studies were identified. The main subjects were related to the detection of urinary stones, the prediction of the outcome of conservative or operative management, the optimization of operative procedures, and the elucidation of the relation of urinary stone chemistry with various factors. Conclusion AI represents a useful tool that provides urologists with numerous amenities, which explains the fact that it has gained ground in the pursuit of stone disease management perfection. The effectiveness of diagnosis and therapy can be increased by using it as an alternative or adjunct to the already existing data. However, little is known concerning the potential of this vast field. Electronic patient records, containing big data, offer AI the opportunity to develop and analyze more precise and efficient diagnostic and treatment algorithms. Nevertheless, the existing applications are not generalizable in real-life practice, and high-quality studies are needed to establish the integration of AI in the management of urinary stone disease.
Collapse
Affiliation(s)
- Anastasios Anastasiadis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Antonios Koudonas
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Georgios Langas
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Stavros Tsiakaras
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Dimitrios Memmos
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Evangelos N. Symeonidis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Ioannis Vakalopoulos
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Georgios Dimitriadis
- 1st Department of Urology, Aristotle University of Thessaloniki, School of Medicine, “G.Gennimatas” General Hospital, Thessaloniki, Greece
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Connors BA, Gardner T, Liu Z, Lingeman JE, Kreider W, Williams JC. Functional and Morphological Changes Associated with Burst Wave Lithotripsy-Treated Pig Kidneys. J Endourol 2022; 36:1580-1585. [PMID: 35920117 PMCID: PMC9718432 DOI: 10.1089/end.2022.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose: Burst wave lithotripsy (BWL) is a new technique for comminution of urinary stones. This technology is noninvasive, has a low positive pressure magnitude, and is thought to produce minor amounts of renal injury. However, little is known about the functional changes related to BWL treatment. In this study, we sought to determine if clinical BWL exposure produces a functional or morphological change in the kidney. Materials and Methods: Twelve female pigs were prepared for renal clearance assessment and served as either sham time controls (6) or were treated with BWL (6). In the treated group, 1 kidney in each pig was exposed to 18,000 pulses at 10 pulses/s with 20 cycles/pulse. Pressure levels related to each pulse were 12 and -7 MPa. Inulin (glomerular filtration rate, GFR) and para-aminohippuric acid (effective renal plasma flow, eRPF) clearance was measured before and 1 hour after treatment. Lesion size analysis was performed to assess the volume of hemorrhagic tissue injury created by each treatment (% FRV). Results: No visible gross hematuria was observed in any of the collected urine samples of the treated kidneys. BWL exposure also did not lead to a change in GFR or eRPF after treatment, nor did it cause a measurable amount of hemorrhage in the tissue. Conclusion: Using the clinical treatment parameters employed in this study, BWL did not cause an acute change in renal function or a hemorrhagic lesion.
Collapse
Affiliation(s)
- Bret A. Connors
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tony Gardner
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziyue Liu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E. Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wayne Kreider
- Applied Physics Laboratory, University of Washington, Seattle, Washington, USA
| | - James C. Williams
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW Artificial intelligence in medicine has allowed for efficient processing of large datasets to perform cognitive tasks that facilitate clinical decision-making, and it is an emerging area of research. This review aims to highlight the most pertinent and recent research in artificial intelligence in endourology, where it has been used to optimize stone diagnosis, support decision-making regarding management, predict stone recurrence, and provide new tools for bioinformatics research within endourology. RECENT FINDINGS Artificial neural networks (ANN) and machine learning approaches have demonstrated high accuracy in predicting stone diagnoses, stone composition, and outcomes of spontaneous stone passage, shockwave lithotripsy (SWL), or percutaneous nephrolithotomy (PCNL); some of these models outperform more traditional predictive models and existing nomograms. In addition, these approaches have been used to predict stone recurrence, quality of life scores, and provide novel methods of mining the electronic medical record for research. SUMMARY Artificial intelligence can be used to enhance existing approaches to stone diagnosis, management, and prevention to provide a more individualized approach to endourologic care. Moreover, it may support an emerging area of bioinformatics research within endourology. However, despite high accuracy, many of the published algorithms lack external validity and require further study before they are more widely adopted.
Collapse
|
4
|
Hameed BMZ, Shah M, Naik N, Rai BP, Karimi H, Rice P, Kronenberg P, Somani B. The Ascent of Artificial Intelligence in Endourology: a Systematic Review Over the Last 2 Decades. Curr Urol Rep 2021; 22:53. [PMID: 34626246 PMCID: PMC8502128 DOI: 10.1007/s11934-021-01069-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review To highlight and review the application of artificial intelligence (AI) in kidney stone disease (KSD) for diagnostics, predicting procedural outcomes, stone passage, and recurrence rates. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Recent Findings This review discusses the newer advancements in AI-driven management strategies, which holds great promise to provide an essential step for personalized patient care and improved decision making. AI has been used in all areas of KSD including diagnosis, for predicting treatment suitability and success, basic science, quality of life (QOL), and recurrence of stone disease. However, it is still a research-based tool and is not used universally in clinical practice. This could be due to a lack of data infrastructure needed to train the algorithms, wider applicability in all groups of patients, complexity of its use and cost involved with it. Summary The constantly evolving literature and future research should focus more on QOL and the cost of KSD treatment and develop evidence-based AI algorithms that can be used universally, to guide urologists in the management of stone disease.
Collapse
Affiliation(s)
- B M Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.,iTRUE: International Training and Research, Uro-Oncology and Endourology, Manipal, Karnataka, India
| | - Milap Shah
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.,iTRUE: International Training and Research, Uro-Oncology and Endourology, Manipal, Karnataka, India
| | - Nithesh Naik
- iTRUE: International Training and Research, Uro-Oncology and Endourology, Manipal, Karnataka, India. .,Department of Mechanical and Manufacturing Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
| | - Bhavan Prasad Rai
- iTRUE: International Training and Research, Uro-Oncology and Endourology, Manipal, Karnataka, India.,Freeman Hospital, Newcastle upon Tyne, UK
| | - Hadis Karimi
- Department of Pharmacy, Manipal College of Pharmaceuticals, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Patrick Rice
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Bhaskar Somani
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.,iTRUE: International Training and Research, Uro-Oncology and Endourology, Manipal, Karnataka, India.,Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| |
Collapse
|
5
|
Connors BA, Gardner T, Liu Z, Lingeman JE, Williams JC. Renal Protection Phenomenon Observed in a Porcine Model After Electromagnetic Lithotripsy Using a Treatment Pause. J Endourol 2021; 35:682-686. [PMID: 33472540 DOI: 10.1089/end.2020.0681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Pretreating the kidney with 100 low-energy shock waves (SWs) with a time pause before delivering a clinical dose of SWs (Dornier HM-3, 2000 SWs, 24 kV, and 120 SWs/min) has been shown to significantly reduce the size of the hemorrhagic lesion produced in that treated kidney, compared to a protocol without pretreatment. It has been assumed that a similar reduction in injury will occur with lithotripters other than the HM-3, but experiments to confirm this assumption are lacking. In this study, we sought to verify that the lesion protection phenomenon also occurs in a lithotripter using an electromagnetic shock source and dry-head coupling. Materials and Methods: Eleven female pigs were placed in a Dornier Compact S lithotripter where the left kidney of each animal was targeted for lithotripsy treatment. Some kidneys received 2500 SWs at power level (PL) = 5 (120 SWs/min) while some kidneys were pretreated with 100 SWs at PL = 1, with a 3-minute time pause, followed immediately by 2500 SWs at PL = 5 (120 SWs/min). Lesion size analysis was performed to assess the volume of hemorrhagic tissue injury created by each treatment regimen (% functional renal volume). Results: Lesion size fell by 85% (p = 0.01) in the 100 SW pretreatment group compared to the injury produced by a regimen without pretreatment. Conclusions: The results suggest that the treatment pause protection phenomenon occurs with a Dornier Compact S, a machine distinctly different from the Dornier HM-3. This result also suggests that this phenomenon may be observed generally in SW lithotripters.
Collapse
Affiliation(s)
- Bret A Connors
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Tony Gardner
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ziyue Liu
- Department of Biostatistics, and Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - James C Williams
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
6
|
Frontal Occipital and Frontal Temporal Horn Ratios: Comparison and Validation of Head Ultrasound-Derived Indexes With MRI and Ventricular Volumes in Infantile Ventriculomegaly. AJR Am J Roentgenol 2019; 213:925-931. [DOI: 10.2214/ajr.19.21261] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
7
|
Maxwell AD, Wang YN, Kreider W, Cunitz BW, Starr F, Lee D, Nazari Y, Williams JC, Bailey MR, Sorensen MD. Evaluation of Renal Stone Comminution and Injury by Burst Wave Lithotripsy in a Pig Model. J Endourol 2019; 33:787-792. [PMID: 31016998 DOI: 10.1089/end.2018.0886] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Burst wave lithotripsy is an experimental technology to noninvasively fragment kidney stones with focused bursts of ultrasound (US). This study evaluated the safety and effectiveness of specific lithotripsy parameters in a porcine model of nephrolithiasis. Methods: A 6- to 7-mm human kidney stone was surgically implanted in each kidney of three pigs. A burst wave lithotripsy US transducer with an inline US imager was coupled to the flank and the lithotripter focus was aligned with the stone. Each stone was exposed to burst wave lithotripsy at 6.5 to 7 MPa focal pressure for 30 minutes under real-time image guidance. After treatment, the kidneys were removed for gross, histologic, and MRI assessment. Stone fragments were retrieved from the kidney to determine the mass comminuted to pieces <2 mm. Results: On average, 87% of the stone mass was reduced to fragments <2 mm. In three of five treatments, stones were completely comminuted to <2-mm fragments. In two of five treatments, stones were partially disintegrated, but larger fragments remained. One stone was not treated because no suitable acoustic window was identified. No injury was detected through gross, histologic, or MRI examination in the parenchymal tissue, although petechial damage and surface erosion were identified on the urothelium of the collecting system limited to the area around the stone. Conclusion: Burst wave lithotripsy can consistently produce stone fragments small enough to spontaneously pass by transcutaneous administration of US pulses. The data suggest that such exposures produce minimal injury to the kidney and urinary tract.
Collapse
Affiliation(s)
- Adam D Maxwell
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Yak-Nam Wang
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Wayne Kreider
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Bryan W Cunitz
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Frank Starr
- Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Donghoon Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Yasser Nazari
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - James C Williams
- Department of Anatomy and Cell Biology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana
| | - Michael R Bailey
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Center for Industrial and Medical Ultrasound, Applied Physics Laboratory, University of Washington, Seattle, Washington
| | - Mathew D Sorensen
- Department of Urology, University of Washington School of Medicine, Seattle, Washington.,Division of Urology, Department of Veterans Affairs Medical Center, Seattle, Washington
| |
Collapse
|
8
|
May PC, Kreider W, Maxwell AD, Wang YN, Cunitz BW, Blomgren PM, Johnson CD, Park JSH, Bailey MR, Lee D, Harper JD, Sorensen MD. Detection and Evaluation of Renal Injury in Burst Wave Lithotripsy Using Ultrasound and Magnetic Resonance Imaging. J Endourol 2017; 31:786-792. [PMID: 28521550 DOI: 10.1089/end.2017.0202] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Burst wave lithotripsy (BWL) is a transcutaneous technique with potential to safely and effectively fragment renal stones. Preclinical investigations of BWL require the assessment of potential renal injury. This study evaluates the capabilities of real-time ultrasound and MRI to detect and evaluate BWL injury that was induced in porcine kidneys. MATERIALS AND METHODS Ten kidneys from five female farm pigs were treated with either a 170 or 335 kHz BWL transducer using variable treatment parameters and monitored in real-time with ultrasound. Eight kidneys were perfusion fixed and scanned with a 3-Tesla MRI scanner (T1-weighted, T2-weighted, and susceptibility-weighted imaging), followed by processing via an established histomorphometric technique for injury quantification. In addition, two kidneys were separately evaluated for histologic characterization of injury quality. RESULTS Observed B-mode hyperechoes on ultrasound consistent with cavitation predicted the presence of BWL-induced renal injury with a sensitivity and specificity of 100% in comparison to the histomorphometric technique. Similarly, MRI detected renal injury with a sensitivity of 90% and specificity of 100% and was able to identify the scale of lesion volumes. The injuries purposefully generated with BWL were histologically similar to those formed by shock wave lithotripsy. CONCLUSIONS BWL-induced renal injury can be detected with a high degree of sensitivity and specificity by real-time ultrasound and post-treatment ex vivo MRI. No injury occurred in this study without cavitation detected on ultrasound. Such capabilities for injury detection and lesion volume quantification on MRI can be used for preclinical testing of BWL.
Collapse
Affiliation(s)
- Philip C May
- 1 University of Washington Applied Physics Lab , Center for Industrial and Medical Ultrasound, Seattle, Washington.,2 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Wayne Kreider
- 1 University of Washington Applied Physics Lab , Center for Industrial and Medical Ultrasound, Seattle, Washington
| | - Adam D Maxwell
- 2 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Yak-Nam Wang
- 1 University of Washington Applied Physics Lab , Center for Industrial and Medical Ultrasound, Seattle, Washington
| | - Bryan W Cunitz
- 1 University of Washington Applied Physics Lab , Center for Industrial and Medical Ultrasound, Seattle, Washington
| | - Philip M Blomgren
- 3 Department of Anatomy and Cell Biology, Indiana University , Indianapolis, Indiana
| | - Cynthia D Johnson
- 3 Department of Anatomy and Cell Biology, Indiana University , Indianapolis, Indiana
| | - Joshua S H Park
- 4 Department of Radiology, University of Washington , Seattle, Washington
| | - Michael R Bailey
- 1 University of Washington Applied Physics Lab , Center for Industrial and Medical Ultrasound, Seattle, Washington.,2 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Donghoon Lee
- 4 Department of Radiology, University of Washington , Seattle, Washington
| | - Jonathan D Harper
- 2 Department of Urology, University of Washington School of Medicine , Seattle, Washington
| | - Mathew D Sorensen
- 2 Department of Urology, University of Washington School of Medicine , Seattle, Washington.,5 Division of Urology, Department of Veteran Affairs Medical Center , Seattle, Washington
| |
Collapse
|