Hyun Ju Jeong

Purpose: To compare the accuracy of portable ultrasound bladder scanner (PUBS) for measuring bladder volume (BV) using manual fanning scan (MFS) and traditional motorized scan (TMS) methods.Methods: Patients with lower urinary tract symptoms who underwent a urodynamic study at the urology outpatient clinic from October to December 2024 were prospectively enrolled. BV was measured using TMS-type (TMS-BV) and MFS-type (MFS-BV) PUBS prior to free uroflowmetry. True BV (T-BV) was defined as the sum of the voided volume and the postvoid residual volume drained through the urethral catheter after voiding. TMS-BV and MFS-BV were compared and analyzed against T-BV.Results: Data from 39 patients (30 males and 9 females; mean age, 65.3±14.8 years) were analyzed. TMS-BV (230.9±157.9 mL) and MFS-BV (222.6±154.2 mL) did not differ significantly from T-BV (230.6±156.6 mL) (P>0.05). Comparison of the percentage of difference in volume between TMS-BV and MFS-BV across 100-mL BV ranges revealed no significant difference (P>0.05). The mean difference between TMS-BV and T-BV (0.2±50.2) did not differ significantly from the mean difference between MFS-BV and T-BV (-8.0±69.1) (P>0.05). The correlation between TMS-BV and T-BV (R2=0.90) was stronger than that between MFS-BV and T-BV (R2=0.81).Conclusions: The correlation between MFS-type PUBS and T-BV was lower than that between TMS-type PUBS and T-BV. However, the measurement accuracy of BV was similar using both methods.

Objective: We aimed to prospectively investigate whether bladder volume measured using deep learning artificial intelligence (AI) algorithms (AI‐BV) is more accurate than that measured using conventional methods (C‐BV) if using a portable ultrasound bladder scanner (PUBS).Patients and Methods: Patients who underwent filling cystometry because of lower urinary tract symptoms between January 2021 and July 2022 were enrolled. Every time the bladder was filled serially with normal saline from 0 mL to maximum cystometric capacity in 50 mL increments, C‐BV was measured using PUBS. Ultrasound images obtained during this process were manually annotated to define the bladder contour, which was used to build a deep learning AI model. The true bladder volume (T‐BV) for each bladder volume range was compared with C‐BV and AI‐BV for analysis.Results: We enrolled 250 patients (213 men and 37 women), and a deep learning AI model was established using 1912 bladder images. There was a significant difference between C‐BV (205.5 ± 170.8 mL) and T‐BV (190.5 ± 165.7 mL) (p = 0.001), but no significant difference between AI‐BV (197.0 ± 161.1 mL) and T‐BV (190.5 ± 165.7 mL) (p = 0.081). In bladder volume ranges of 101–150, 151–200, and 201–300 mL, there were significant differences in the percentage of volume differences between [C‐BV and T‐BV] and [AI‐BV and T‐BV] (p < 0.05), but no significant difference if converted to absolute values (p > 0.05). C‐BV (R² = 0.91, p < 0.001) and AI‐BV (R² = 0.90, p < 0.001) were highly correlated with T‐BV. The mean difference between AI‐BV and T‐BV (6.5 ± 50.4) was significantly smaller than that between C‐BV and T‐BV (15.0 ± 50.9) (p = 0.001).Conclusion: Following image pre‐processing, deep learning AI‐BV more accurately estimated true BV than conventional methods in this selected cohort on internal validation. Determination of the clinical relevance of these findings and performance in external cohorts requires further study.Trial Registration: The clinical trial was conducted using an approved product for its approved indication, so approval from the Ministry of Food and Drug Safety (MFDS) was not required. Therefore, there is no clinical trial registration number.

Objective: This study aimed to analyze the outcomes of clinical management of patients with interstitial cystitis (IC).Patients and Methods: We retrospectively analyzed the electronic medical records of patients with IC who visited outpatient clinics with pelvic pain between October 2005 and December 2019. Pain was managed with cystoscopic surgery based on transurethral fulguration (TUF) for bladder ulcers. Cystectomy was performed for intractable pelvic pain. Patients were regularly followed and clinical outcomes were analyzed.Results: Of the 275 patients, 240 patients (57 men, 23.7% and 183 women, 76.3%) underwent initial cystoscopic surgery. Overall median follow‐up duration was 21.0 months and mean number of TUF was 1.0 (±0.8). Of these 240 patients, 71 (29.6%) did not require further surgical treatment, whereas 64 (26.7%) required a second TUF for recurrent pelvic pain. The median recurrence interval was 12.0 (interquartile range: 6.0–25.0) months. Of the 64 patients who received a second TUF, 15 (23.4%) underwent a third TUF after a median of 12.0 (interquartile range: 12.0–32.0) months. Of the 15 patients who received a third TUF, five patients required a fourth TUF because of recurrence of pain. One patient received until a seventh TUF. Overall, 168 of 240 patients (70.0%) achieved pain control with TUF. Eighteen patients (7.5%) underwent cystectomy (six patients with urinary diversion and 12 patients with cystectomy with bladder replacement).Conclusion: TUF‐based cystoscopic surgery is an effective basic treatment for pelvic pain management in patients with IC.

Purpose: This study investigated urinary incontinence (UI) following holmium laser enucleation of the prostate (HoLEP), based on the postoperative period, type of UI, and severity according to prostate volume.Methods: We analyzed prospectively collected data from patients who underwent HoLEP for benign prostatic hyperplasia at Seoul National University Hospital between January 2010 and June 2022. Patients were followed-up at 2 weeks, 3 months, and 6 months postoperatively. The patients were divided into 3 prostate volume groups: A (30–80 mL), B (81–120 mL), and C (>120 mL). We compared clinical outcomes and UI rates between the groups.Results: In total, 1,675 patients were included. The preoperative urgency UI (UUI) rate was 16.1%, with no significant difference between the groups (P=0.81). Two weeks postoperatively, the UUI rate was 6.0% (including a de novo UUI rate of 4.2%), with no significant differences between the groups. The stress UI (SUI) rate at 2 weeks postoperatively was 6.3%, and increased with larger prostate volume (P=0.04). The UUI and SUI rates decreased to 0.9% and 1.2%, respectively, 6 months postoperatively. Six months postoperatively, the SUI rate was significantly lower in group A (P=0.02), whereas the UUI rate did not differ between the groups (P=0.69).Conclusions: Our results demonstrated that the preoperative UUI rate was high at baseline. Both the UUI and SUI rates continuously decreased up to 6 months postoperatively. Although the SUI rates significantly differed according to prostate volume, there was no significant difference in the UUI rate.

Objective: To evaluate the effect of detrusor underactivity (DUA) on the postoperative outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic hyperplasia (BPH). Patients and Methods: Patients with BPH who underwent HoLEP between January 2018 and December 2022 were enrolled in this prospective database study. Patients were divided into DUA (bladder contractility index [BCI] max ], post‐void residual urine volume [PVR]) and subjective outcomes (International Prostate Symptom Score [IPSS], Overactive Bladder Symptom Score [OABSS], satisfaction with treatment question [STQ], overall response assessment [ORA], and willingness to undergo surgery question [WUSQ]) were compared between the two groups before surgery, and at 3 and 6 months after HoLEP. Results: A total of 689 patients, with a mean (standard deviation [SD]) age of 69.8 (7.1) years, were enrolled. The mean (SD) BCI in the non‐DUA (325 [47.2%]) and DUA (364 [52.8%]) groups was 123.4 (21.4) and 78.6 (14.2), respectively. Both objective (Q _max and PVR) and subjective (IPSS, IPSS‐quality of life, and OABSS) outcomes after surgery significantly improved in both groups. The Q _max was lower in the DUA than in the non‐DUA group postoperatively. At 6 months postoperatively, the total IPSS was higher in the DUA than in the non‐DUA group. There were no significant differences in surgical complications between the two groups. Responses to the STQ, ORA, and WUSQ at 6 months postoperatively demonstrated that the patients were satisfied with the surgery (90.5% in the DUA group; 95.2% in the non‐DUA group), their symptoms improved with surgery (95.9% in the DUA group; 100.0% in the non‐DUA group), and they were willing to undergo surgery again (95.9% in the DUA group; 97.9% in the non‐DUA group). There were no significant differences in the responses to the STQ and WUSQ between the two groups. Conclusion: Our midterm results demonstrated that patients with BPH and DUA showed minimal differences in clinical outcomes after HoLEP compared to those without DUA. The overall satisfaction was high in the DUA group.

Objective: This study evaluates surgical outcomes in benign prostatic hyperplasia (BPH) patients undergoing transurethral enucleation using various holmium laser (HoLEP) settings and/or bipolar devices (BipoLEP). Design: This study was retrospective. Methods: We retrospectively analyzed 158 BPH patients treated surgically, categorized by method: BipoLEP ( n = 28), HoLEP with short pulse (HoLEP-SP, n = 26), HoLEP with long pulse and low energy (HoLEP-LP/LE, n = 29), HoLEP with long pulse and high energy (HoLEP-LP/HE, n = 26), HoLEP using Moses technology (HoLEP-Mo, n = 19), and a combination of HoLEP and BipoLEP (HoLEP-mix, n = 30). We assessed enucleation, morcellation, coagulation, and overall operation efficiency, along with complications at immediate, 2-week, and 3-month postoperative intervals. Results: The HoLEP-LP/LE group exhibited the highest overall operation efficiency ( p < 0.05). The BipoLEP and HoLEP-SP groups had lower enucleation efficiency ( p < 0.05). HoLEP-LP/LE and BipoLEP showed superior coagulation efficiency ( p < 0.05). Excluding hard nodule cases, the HoLEP-mix group had reduced morcellation efficiency compared to HoLEP-LP/LE ( p < 0.05). Complication rates did not significantly differ between groups ( p > 0.05). Conclusion: The HoLEP-LP/LE procedure demonstrated superior performance in enucleation, morcellation, coagulation, and overall operation efficiency. Complication rates were comparable across all groups. BipoLEP, while less efficient in enucleation than some HoLEP settings, proved effective and safe. In addition, the Moses technology may offer enhanced bleeding control.