Predicting stone composition via machine-learning models trained on intra‐operative endoscopic digital images
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Abstract Objectives The aim of this study was to use deep learning (DL) of intraoperative images of urinary stones to predict the composition of urinary stones. In this way, the laser frequency and intensity can be adjusted in real time to reduce operation time and surgical trauma. Materials and methods A total of 490 patients who underwent holmium laser surgery during the two-year period from March 2021 to March 2023 and had stone analysis results were collected by the stone laboratory. A total of 1658 intraoperative stone images were obtained. The eight stone categories with the highest number of stones were selected by sorting. Single component stones include calcium oxalate monohydrate (W1), calcium oxalate dihydrate (W2), magnesium ammonium phosphate hexahydrate, apatite carbonate (CH) and anhydrous uric acid (U). Mixed stones include W2 + U, W1 + W2 and W1 + CH. All stones have intraoperative videos. More than 20 intraoperative high-resolution images of the stones, including the surface and core of the stones, were available for each patient via FFmpeg command screenshots. The deep convolutional neural network (CNN) ResNet-101 (ResNet, Microsoft) was applied to each image as a multiclass classification model. Results The composition prediction rates for each component were as follows: calcium oxalate monohydrate 99% (n = 142), calcium oxalate dihydrate 100% (n = 29), apatite carbonate 100% (n = 131), anhydrous uric acid 98% (n = 57), W1 + W2 100% (n = 82), W1 + CH 100% ( n = 20) and W2 + U 100% (n = 24). The overall weighted recall of the cellular neural network component analysis for the entire cohort was 99%. Conclusion This preliminary study suggests that DL is a promising method for identifying urinary stone components from intraoperative endoscopic images. Compared to intraoperative identification of stone components by the human eye, DL can discriminate single and mixed stone components more accurately and quickly. At the same time, based on the training of stone images in vitro, it is closer to the clinical application of stone images in vivo. This technology can be used to identify the composition of stones in real time and to adjust the frequency and energy intensity of the holmium laser in time. The prediction of stone composition can significantly shorten the operation time, improve the efficiency of stone surgery and prevent the risk of postoperative infection.Keywords:
Anhydrous
To study the chemical composition of upper renal tract (renal and ureteric) calculi in Multan.Department of Urology, Nishtar Hospital, Multan.September 1992 to February 1999.A total of 700 renal and ureteric calculi were analyzed by chemical method of Hodgkinson.The commonest were uric acid (28.1%) calculi, followed in frequency by calcium oxalate calculi (26.1%), mixed calculi containing calcium oxalate and uric acid (21.8%) and calculi containing calcium oxalate and calcium phosphate (10.4%). Other variety of calculi were less common.Uric acid, calcium oxalate and mixed uric acid and calcium oxalate calculi are the main types in Multan region (JPMA 50:145, 2000).
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Sodium oxalate (402 mg) was administered in a single dose to 10 healthy volunteers receiving a controlled diet. Half the group received 3 times 10 g Colestid and the other half 4 times 2 g Andursil. On the 5th day the oxalate load was repeated. Urine was collected within 32 hours following oxalate application in 8 fractions. In each fraction the levels of oxalate, calcium, phosphate and uric acid were determined. The amount of oxalate, phosphate and uric acid measured in the group receiving Colestid was lower in all fractions. Peak excretions of oxalate found in unmedicated volunteers were suppressed following oxalate load. In the group receiving Andursil, only the excretion of phosphate was decreased. The results presented suggest that Colestid may be promising in the prevention of calcium-oxalate-urolithiasis.
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No AccessJournal of UrologyCalculus1 May 1983Pathogenesis and Clinical Course of Mixed Calcium Oxalate and Uric Acid Nephrolithiasis S. Millman, A.L. Strauss, J.H. Parks, and F.L. Coe S. MillmanS. Millman More articles by this author , A.L. StraussA.L. Strauss More articles by this author , J.H. ParksJ.H. Parks More articles by this author , and F.L. CoeF.L. Coe More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)52561-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Pathogenesis and Clinical Course of Mixed Calcium Oxalate and Uric Acid Nephrolithiasis." The Journal of Urology, 129(5), p. 1085 © 1983 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 129Issue 5May 1983Page: 1085 Advertisement Copyright & Permissions© 1983 by The American Urological Association Education and Research, Inc.MetricsAuthor Information S. Millman More articles by this author A.L. Strauss More articles by this author J.H. Parks More articles by this author F.L. Coe More articles by this author Expand All Advertisement PDF downloadLoading ...
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Hyperuricosuric patients may form uric acid kidney stones and mixed stones containing both calcium oxalate and uric acid. Some of these patients form pure calcium oxalate stones. Explanation of this syndrome was based on the plausibility of epitaxial growth of calcium oxalate on uric acid crystals acting as substrates. In spite of convincing crystallographic consideration, laboratory experiments did not demonstrate any growth of calcium oxalate on uric acid seeds. An amino acid evidently adsorbing on uric acid seeds and attracting calcium ions could act as a mediating agent, thus realizing the potential of the epitaxial growth of calcium oxalate on uric acid crystals. Administration of allopurinol to hyperuricosuric calcium oxalate stone formers reduced the level of uric acid, consequently preventing the creation of uric acid crystals in urine. It should have removed the direct cause for the formation of calcium oxalate stones. Though undoubtedly more effective than placebo, the therapy with allopurinol was not unequivocally successful. Combined therapy using allopurinol and other drugs which were proved to be beneficial for idiopathic calcium oxalate stone formers, seems to give improved results. The use of procedures for evaluating the effect of therapy on risk factors has been started to predict success in individual cases.
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Nephrology
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A survey shall be given of the present state of prevention and therapy of urolithiasis as well as of the up to now much restricted possibilities of the chemolitholysis. Particular attention is paid to calcium on account of its participation in the development of oxalate and phosphate calculi which together might be 70--80% of all calculi as well as to the rather limited possibilities of the reduction of the oxalate secretion in the urine. The encouragement of the oxalate lithiasis by increased uric acid in the urine as well as the reduction of the frequency of relapses not only of the concrements of the uric acid but also of the oxalate concrements by the uricostatic Allopurinol (e.g. zyloric) is dealt with.
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It has been a long time since uric acid was suggested to be a promoting factor in calcium oxalate stones, and a number of in vitro studies have been carried out on the relationship between uric acid or urate and calcium oxalate. Concerning in vivo studies, urate or calcium oxalate stone-forming diets were given alone in most cases, and diets that induce formation of stones with different composition have not been given in combinations. We administered a low-concentration oxalemic diet, and a mixed diet containing oxalic acid and uric acid, and biochemically and histologically studied the effects of oxalate and uric acid on kidney stone formation. In the kidney of the animals given the mixed diet, formation of crystalloids of uric acid or urate was evident when no crystallization was noted in the kidney of those given the low concentration oxalemic diet alone. The morphological differences in the uric acid and urate crystalloids in the kidney and the process leading to crystallization of calcium oxalate were examined under transmission and scanning electron microscopy. Histological examination indicated that these uric acid crystals and urate crystals serve as seeds and induce formation and epitaxial growth of calcium oxalate crystals. Our in vivo study provides additional evidence that uric acid is a promoting factor in calcium oxalate stone formation.
Oxalic Acid
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Supersaturation
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Urinary calcium
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