Robot-assisted surgery has profoundly influenced current forms of minimally invasive surgery. However, in transurethral suburethral urological surgical robots, they need to work in a liquid environment. This causes vaporization of the liquid when shearing and heating is performed, resulting in bubble atomization that affects the visual perception of the robot. This can lead to the need for uninterrupted pauses in the surgical procedure, which makes the surgery take longer. To address the atomization characteristics of liquids under urological surgical robotic vision, we propose an unsupervised zero-shot dehaze method (RSF-Dehaze) for urological surgical robotic vision. Specifically, the proposed Region Similarity Filling Module (RSFM) of RSF-Dehaze significantly improves the recovery of blurred region tissues. In addition, we organize and propose a dehaze dataset for robotic vision in urological surgery (USRobot-Dehaze dataset). In particular, this dataset contains the three most common urological surgical robot operation scenarios. To the best of our knowledge, we are the first to organize and propose a publicly available dehaze dataset for urological surgical robot vision. The pr
Objective: Conventional urodynamics (UDS) provide critical diagnostic information, but requires invasive dual catheterization and manual labeling of clinically important events. Wireless, catheter-free bladder function tests are becoming available for home use, but only provide vesical pressure (Pves). We developed a machine learning framework that was trained and externally validated on UDS data for automated urological event classification from single-channel (Pves) recordings. Methods: We analyzed 118 annotated UDS traces segmented into 0.8-second Pves intervals. Using the discrete wavelet transform, we extracted 55 statistical features per segment. Consecutive segments (233,338 segments; three classes) sharing the same class, abdominal (ABD), detrusor overactivity (DO), or voiding contraction (VOID), were grouped into events, and median feature aggregation was applied to derive event-level representations. Using an imbalanced dataset, we trained a two-stage multilayer perceptron (MLP): Stage 1 distinguished VOID vs non-VOID, and Stage 2 classified non-VOID into ABD and DO. The model was trained on two independent datasets and externally validated on a third independent dataset.
Tumor documentation in Germany is largely done manually, requiring reading patient records and entering data into structured databases. Large language models (LLMs) could potentially enhance this process by improving efficiency and reliability. This evaluation tests eleven different open source LLMs with sizes ranging from 1-70 billion model parameters on three basic tasks of the tumor documentation process: identifying tumor diagnoses, assigning ICD-10 codes, and extracting the date of first diagnosis. For evaluating the LLMs on these tasks, a dataset of annotated text snippets based on anonymized doctors' notes from urology was prepared. Different prompting strategies were used to investigate the effect of the number of examples in few-shot prompting and to explore the capabilities of the LLMs in general. The models Llama 3.1 8B, Mistral 7B, and Mistral NeMo 12 B performed comparably well in the tasks. Models with less extensive training data or having fewer than 7 billion parameters showed notably lower performance, while larger models did not display performance gains. Examples from a different medical domain than urology could also improve the outcome in few-shot prompting, wh
Bladder pressure monitoring systems are increasingly vital in diagnosing and managing urinary tract dysfunction. Existing solutions rely heavily on hand-crafted features and shallow classifiers, limiting their adaptability to complex signal dynamics. We propose a one-layer streaming transformer model for real-time classification of bladder pressure states, operating on wavelet-transformed representations of raw time-series data. Our model incorporates temporal multi-head self-attention and state caching, enabling efficient online inference with high adaptability. Trained on a dataset of 91 patients with 20,000-80,000 samples each, our method demonstrates improved accuracy, higher energy- and latency-efficiency. Implementation considerations for edge deployment on low-power hardware, such as edge graphical processing units (GPU) and micro-controllers, are also discussed.
The author reviews the computer and robotic tools available to urologists to help in diagnosis and technical procedures. The first part concerns the contribution of robotics and presents several systems at various stages of development (laboratory prototypes, systems under validation or marketed systems). The second part describes image fusion tools and navigation systems currently under development or evaluation. Several studies on computerized simulation of urological procedures are also presented.
Purpose: Non-invasive grading of prostate cancer (PCa) from micro-ultrasound (micro-US) could expedite triage and guide biopsies toward the most aggressive regions, yet current models struggle to infer tissue micro-structure at coarse imaging resolutions. Methods: We introduce an unpaired histopathology knowledge-distillation strategy that trains a micro-US encoder to emulate the embedding distribution of a pretrained histopathology foundation model, conditioned on International Society of Urological Pathology (ISUP) grades. Training requires no patient-level pairing or image registration, and histopathology inputs are not used at inference. Results: Compared to the current state of the art, our approach increases sensitivity to clinically significant PCa (csPCa) at 60% specificity by 3.5% and improves overall sensitivity at 60% specificity by 1.2%. Conclusion: By enabling earlier and more dependable cancer risk stratification solely from imaging, our method advances clinical feasibility. Source code will be publicly released upon publication.
Deep learning models for prostate MRI-based cancer grading may encode clinical covariates that either reflect useful disease-related signal or non-generalising shortcut information, but their role is usually assumed. We propose a causal-reasoning framework for probing covariate dependence in MRI-based International Society of Urological Pathology (ISUP) Grade Group prediction. Rather than treating mpMRI as a direct cause of grade, we model MRI appearance and ISUP grade as observations of latent tumour pathology, and test whether candidate clinical variables act as nuisance correlates, disease-related proxies, or irrelevant covariates in the learned representation. We implement this using an adversarial framework that suppresses the decodability of individual clinical covariate at a time while preserving MRI-based grade prediction. The approach is developed and evaluated on 2,903 prostate MRI examinations, with external validation on 576 patients. We report a set of interesting and previously under-explored imaging-to-clinical-variable interactions in the context of deep learning generalisation. For examples, in binary ISUP Grade Group $\geq2$ classification, suppressing age, BMI, a
Whole slide images (WSIs) provide rich diagnostic information for computational pathology, but their gigapixel scale, stain variation, scanner differences, tissue artifacts, and limited expert annotation make robust model training challenging. This paper presents a multi-source Masked Autoencoder (MAE) framework, named ProsMAE, for histopathology representation learning. Tiles from Prostate cANcer graDe Assessment (PANDA), CAncer MEtastases in LYmph nOdes challeNge 2017 (CAMELYON17), and BReAst Carcinoma Subtyping (BRACS) are used for ProsMAE pretraining to expose the encoder to diverse tissue morphology and acquisition conditions. The learned encoder is transferred for International Society of Urological Pathology (ISUP) grade classification through ProsCLS, using a frozen encoder and a linear classification head. ProsMAE achieved a higher mean validation quadratic weighted kappa (QWK) than the vanilla MAE frozen linear-probe baseline under the evaluated disjoint PANDA split. Repeated-split evaluation remains necessary to further establish robustness across split compositions.
Kidney stone disease ranks among the most prevalent conditions in urology, and understanding the composition of these stones is essential for creating personalized treatment plans and preventing recurrence. Current methods for analyzing kidney stones depend on postoperative specimens, which prevents rapid classification before surgery. To overcome this limitation, we introduce a new approach called the Urinary Stone Segmentation and Classification Network (USCNet). This innovative method allows for precise preoperative classification of kidney stones by integrating Computed Tomography (CT) images with clinical data from Electronic Health Records (EHR). USCNet employs a Transformer-based multimodal fusion framework with CT-EHR attention and segmentation-guided attention modules for accurate classification. Moreover, a dynamic loss function is introduced to effectively balance the dual objectives of segmentation and classification. Experiments on an in-house kidney stone dataset show that USCNet demonstrates outstanding performance across all evaluation metrics, with its classification efficacy significantly surpassing existing mainstream methods. This study presents a promising solu
Prostate cancer grading using the ISUP system (International Society of Urological Pathology) for treatment decisions is highly subjective and requires considerable expertise. Despite advances in computer-aided diagnosis systems, few have handled efficient ISUP grading on Whole Slide Images (WSIs) of prostate biopsies based only on slide-level labels. Some of the general challenges include managing gigapixel WSIs, obtaining patch-level annotations, and dealing with stain variability across centers. One of the main task-specific challenges faced by deep learning in ISUP grading, is the learning of patch-level features of Gleason patterns (GPs) based only on their slide labels. In this scenario, an efficient framework for ISUP grading is developed. The proposed TSOR is based on a novel Task-specific Self-supervised learning (SSL) model, which is fine-tuned using Ordinal Regression. Since the diversity of training samples plays a crucial role in SSL, a patch-level dataset is created to be relatively balanced w.r.t. the Gleason grades (GGs). This balanced dataset is used for pre-training, so that the model can effectively learn stain-agnostic features of the GP for better generalizatio
In this paper, we propose an approach to support the diagnosis of urinary tract diseases, with a focus on bladder cancer, using SHAP (SHapley Additive exPlanations)-based feature selection to enhance the transparency and effectiveness of predictive models. Six binary classification scenarios were developed to distinguish bladder cancer from other urological and oncological conditions. The algorithms XGBoost, LightGBM, and CatBoost were employed, with hyperparameter optimization performed using Optuna and class balancing with the SMOTE technique. The selection of predictive variables was guided by importance values through SHAP-based feature selection while maintaining or even improving performance metrics such as balanced accuracy, precision, and specificity. The use of explainability techniques (SHAP) for feature selection proved to be an effective approach. The proposed methodology may contribute to the development of more transparent, reliable, and efficient clinical decision support systems, optimizing screening and early diagnosis of urinary tract diseases.
Penile measurement is clinically relevant across male reproductive and urogenital health, including conditions such as micropenis, congenital and endocrine disorders, and sexual or urinary dysfunction. However, quantitative assessment of penile size has relied mainly on external length or circumference measurements, which are difficult to standardize, sensitive to measurement conditions, and unable to capture the internal portion of the penis. MRI enables volumetric assessment of the whole penis in vivo, but automated segmentation has not previously been established at population scale. Automated whole-organ volumetry would enable high-throughput phenotyping for multi-omics and clinical studies of male reproductive disease. Here, we present a deep learning framework for whole-penis segmentation in multi-channel DIXON MRI. Using a newly curated expert-annotated training dataset ($n = 145$ subjects; $13,050$ annotated slices) and a double-annotated independent test benchmark ($n = 24$ subjects; $2,160$ double-annotated slices), we optimized a 3D nnU-Net architecture. The model achieved a 5-fold cross-validation Dice score of $0.90$ and performed at observer-level accuracy on the inde
This study presents the first large-scale empirical evaluation of quantum machine learning for predicting antibiotic resistance in clinical urine cultures. Antibiotic resistance is amongst the top threats to humanity, and inappropriate antibiotic use is a main driver of resistance. We developed a Quantum Projective Learning (QPL) approach and executed 60 qubit experiments on IBM Eagle and Heron quantum processing units. While QPL did not consistently outperform classical baselines, potentially reflecting current quantum hardware limitations, it did achieve parity or superiority in specific scenarios, notably for the antibiotic nitrofurantoin and selected data splits, revealing that quantum advantage may be data-dependent. Analysis of data complexity measures uncovered a multivariate signature, which comprised Shannon entropy, Fisher Discriminant Ratio, standard deviation of kurtosis, number of low-variance features, and total correlations. The multivariate model accurately (AUC = 0.88, $p$-value = 0.03) distinguished cases wherein QPL executed on quantum hardware would outperform classical models. This signature suggests that quantum kernels excel in feature spaces with high entrop
Artificial intelligence (AI) is increasingly used in digital pathology. Publicly available histopathology datasets remain scarce, and those that do exist predominantly represent Western populations. Consequently, the generalizability of AI models to populations from less digitized regions, such as the Middle East, is largely unknown. This motivates the public release of our dataset to support the development and validation of pathology AI models across globally diverse populations. We present 1,017 whole slide images by digitizing 339 glass slides of prostate core needle biopsies from a consecutive series of 185 patients collected in Erbil, Iraq. The slides are associated with Gleason scores and International Society of Urological Pathology grades assigned independently by three pathologists. Scanning was performed using two high-throughput scanners (Leica and Hamamatsu) and one compact scanner (Grundium). All slides were de-identified and are provided in their native formats without further conversion. The dataset enables grading concordance analyses, color normalization, and cross-scanner robustness evaluations. The PAR dataset has been deposited to the BioImage Archive under acc
Clinical cystoscopy, the current standard for bladder cancer diagnosis, suffers from significant reliance on physician expertise, leading to variability and subjectivity in diagnostic outcomes. There is an urgent need for objective, accurate, and efficient computational approaches to improve bladder cancer diagnostics. Leveraging recent advancements in deep learning, this study proposes an integrated multi-task deep learning framework specifically designed for bladder cancer diagnosis from cystoscopic images. Our framework includes a robust classification model using EfficientNet-B0 enhanced with Convolutional Block Attention Module (CBAM), an advanced segmentation model based on ResNet34-UNet++ architecture with self-attention mechanisms and attention gating, and molecular subtyping using ConvNeXt-Tiny to classify molecular markers such as HER-2 and Ki-67. Additionally, we introduce a Gradio-based online diagnostic platform integrating all developed models, providing intuitive features including multi-format image uploads, bilingual interfaces, and dynamic threshold adjustments. Extensive experimentation demonstrates the effectiveness of our methods, achieving outstanding accuracy
The non-invasive assessment of increasingly incidentally discovered renal masses is a critical challenge in urologic oncology, where diagnostic uncertainty frequently leads to the overtreatment of benign or indolent tumors. In this study, we developed and validated RenalCLIP using a dataset of 27,866 CT scans from 8,809 patients across nine Chinese medical centers and the public TCIA cohort, a visual-language foundation model for characterization, diagnosis and prognosis of renal mass. The model was developed via a two-stage pre-training strategy that first enhances the image and text encoders with domain-specific knowledge before aligning them through a contrastive learning objective, to create robust representations for superior generalization and diagnostic precision. RenalCLIP achieved better performance and superior generalizability across 10 core tasks spanning the full clinical workflow of kidney cancer, including anatomical assessment, diagnostic classification, and survival prediction, compared with other state-of-the-art general-purpose CT foundation models. Especially, for complicated task like recurrence-free survival prediction in the TCIA cohort, RenalCLIP achieved a
We present MedNuggetizer, https://mednugget-ai.de/; access is available upon request.}, a tool for query-driven extraction and clustering of information nuggets from medical documents to support clinicians in exploring underlying medical evidence. Backed by a large language model (LLM), \textit{MedNuggetizer} performs repeated extractions of information nuggets that are then grouped to generate reliable evidence within and across multiple documents. We demonstrate its utility on the clinical use case of \textit{antibiotic prophylaxis before prostate biopsy} by using major urological guidelines and recent PubMed studies as sources of information. Evaluation by domain experts shows that \textit{MedNuggetizer} provides clinicians and researchers with an efficient way to explore long documents and easily extract reliable, query-focused medical evidence.
The segmentation of kidney stones is regarded as a critical preliminary step to enable the identification of urinary stone types through machine- or deep-learning-based approaches. In urology, manual segmentation is considered tedious and impractical due to the typically large scale of image databases and the continuous generation of new data. In this study, the potential of the Segment Anything Model (SAM) -- a state-of-the-art deep learning framework -- is investigated for the automation of kidney stone segmentation. The performance of SAM is evaluated in comparison to traditional models, including U-Net, Residual U-Net, and Attention U-Net, which, despite their efficiency, frequently exhibit limitations in generalizing to unseen datasets. The findings highlight SAM's superior adaptability and efficiency. While SAM achieves comparable performance to U-Net on in-distribution data (Accuracy: 97.68 + 3.04; Dice: 97.78 + 2.47; IoU: 95.76 + 4.18), it demonstrates significantly enhanced generalization capabilities on out-of-distribution data, surpassing all U-Net variants by margins of up to 23 percent.
Large Language Models (LLMs) are revolutionizing medical Question-Answering (medQA) through extensive use of medical literature. However, their performance is often hampered by outdated training data and a lack of explainability, which limits clinical applicability. This study aimed to create and assess UroBot, a urology-specialized chatbot, by comparing it with state-of-the-art models and the performance of urologists on urological board questions, ensuring full clinician-verifiability. UroBot was developed using OpenAI's GPT-3.5, GPT-4, and GPT-4o models, employing retrieval-augmented generation (RAG) and the latest 2023 guidelines from the European Association of Urology (EAU). The evaluation included ten runs of 200 European Board of Urology (EBU) In-Service Assessment (ISA) questions, with performance assessed by the mean Rate of Correct Answers (RoCA). UroBot-4o achieved an average RoCA of 88.4%, surpassing GPT-4o by 10.8%, with a score of 77.6%. It was also clinician-verifiable and exhibited the highest run agreement as indicated by Fleiss' Kappa (k = 0.979). By comparison, the average performance of urologists on board questions, as reported in the literature, is 68.7%. Uro
This study presents an innovative AI-driven tool for diagnosing Peyronie's Disease (PD), a condition that affects between 0.3% and 13.1% of men worldwide. Our method uses key point detection on both images and videos to measure penile curvature angles, utilizing advanced computer vision techniques. This tool has demonstrated high accuracy in identifying anatomical landmarks, validated against conventional goniometer measurements. Traditional PD diagnosis often involves subjective and invasive methods, which can lead to patient discomfort and inaccuracies. Our approach offers a precise, reliable, and non-invasive diagnostic tool to address these drawbacks. The model distinguishes between PD and normal anatomical changes with a sensitivity of 96.7% and a specificity of 100%. This advancement represents a significant improvement in urological diagnostics, greatly enhancing the efficacy and convenience of PD assessment for healthcare providers and patients.