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Despite its prevalence in urological interventions, it presents two operational challenges: 1) precise needle placement into the renal pelvis; and 2) avoiding hemorrhage from blood vessel rupture. In this study, we developed an endoscopic optical coherence tomography probe for needle navigation. We conducted experiments on thirty-one human kidneys for two aspects: 1) tissue recognition, and 2) blood vessel detection. Experimental results indicated that renal tissues including cortex, medulla, calyx, sinus fat, and pelvis could be effectively distinguished through structural optical coherence tomography imaging, and renal blood flow could be detected through the Doppler function. Deep learning methods were utilized to automate recognition procedures. For tissue classification, an Inception model was used, achieving a recognition accuracy of 99.6%. For blood vessel detection, an nnU-net model was applied, exhibiting an intersection over union value of 0.8917 for blood vessel and 0.9916 for background.<\/jats:p>","DOI":"10.1038\/s44172-026-00613-8","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T17:03:01Z","timestamp":1772816581000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Percutaneous nephrostomy guidance by a convolutional-neural-network-based optical coherence tomography endoscope"],"prefix":"10.1038","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4645-3227","authenticated-orcid":false,"given":"Chen","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1849-4481","authenticated-orcid":false,"given":"Paul","family":"Calle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qinghao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kar-Ming","family":"Fung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongxin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean G.","family":"Duguay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William B.","family":"Vanlandingham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A.","family":"Bradley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay G.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradon","family":"Nave","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clint","family":"Hostetler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Milam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2860-0334","authenticated-orcid":false,"given":"Chongle","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9499-5384","authenticated-orcid":false,"given":"Qinggong","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"613_CR1","unstructured":"National-Kidney-Foundation. 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