{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:26:09Z","timestamp":1784204769675,"version":"3.55.0"},"reference-count":35,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,8]],"date-time":"2023-01-08T00:00:00Z","timestamp":1673136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Purpose: Post-operative cystography has been used to predict the recovery of postprostatectomy urinary incontinence (PPI) in patients with localized prostate cancer. This study aimed to validate the predictive value of cystography for PPI and utilize a deep learning model to identify favorable and unfavorable features. Methods: Medical records and cystography images of patients who underwent robotic-assisted radical prostatectomy for localized prostate cancer were retrospectively reviewed. Specific cystography features, including anastomosis leakage, a downward bladder neck (BN), and the bladder neck angle, were analyzed for the prediction of PPI recovery. Favorable and unfavorable patterns were categorized based on the three cystography features. The deep learning model used for transfer learning was ResNet 50 and weights were trained on ImageNet. We used 5-fold cross-validation to reduce bias. After each fold, we used a test set to confirm the model\u2019s performance. Result: A total of 170 consecutive patients were included; 31.2% experienced immediate urinary continence after surgery, while 93.5% achieved a pad-free status and 6.5% were still incontinent in the 24 weeks after surgery. We divided patients into a fast recovery group (\u22644 weeks) and a slow recovery group (&gt;4 weeks). Compared with the slow recovery group, the fast recovery group had a significantly lower anastomosis leakage rate, less of a downward bladder neck, and a larger bladder neck angle. Test data used to evaluate the model\u2019s performance demonstrated an average 5-fold accuracy, sensitivity, and specificity of 93.75%, 87.5%, and 100%, respectively. Conclusions: Postoperative cystography features can predict PPI recovery in patients with localized prostate cancer. A deep-learning model can facilitate the identification process. Further validation and exploration are required for the future development of artificial intelligence (AI) in this field.<\/jats:p>","DOI":"10.3390\/jpm13010126","type":"journal-article","created":{"date-parts":[[2023,1,9]],"date-time":"2023-01-09T02:09:39Z","timestamp":1673230179000},"page":"126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome"],"prefix":"10.3390","volume":"13","author":[{"given":"I-Hung","family":"Shao","sequence":"first","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"},{"name":"Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hung-Cheng","family":"Kan","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3642-4687","authenticated-orcid":false,"given":"Hung-Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung 204201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying-Hsu","family":"Chang","sequence":"additional","affiliation":[{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"},{"name":"Division of Urology, Department of Surgery, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital, New Taipei 236017, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang-Kang","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Cheng","family":"Chu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8245-4302","authenticated-orcid":false,"given":"Po-Hung","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Jie","family":"Yu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Keng","family":"Chuang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"See-Tong","family":"Pang","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Te","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333005, Taiwan"},{"name":"College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.eururo.2020.09.042","article-title":"EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent","volume":"79","author":"Mottet","year":"2021","journal-title":"Eur. Urol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"340.e7","DOI":"10.1016\/j.urolonc.2018.03.022","article-title":"Psychological and functional effect of different primary treatments for prostate cancer: A comparative prospective analysis","volume":"36","author":"Sciarra","year":"2018","journal-title":"Urol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"487","DOI":"10.4111\/kju.2015.56.7.487","article-title":"Multiparametric magnetic resonance imaging for prostate cancer: A review and update for urologists","volume":"56","author":"Yoo","year":"2015","journal-title":"Korean J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1159\/000099338","article-title":"Analysis of risk factors for urinary incontinence after radical prostatectomy","volume":"78","author":"Majoros","year":"2007","journal-title":"Urol. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1016\/S0022-5347(17)32396-0","article-title":"Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years","volume":"152","author":"Walsh","year":"1994","journal-title":"J. Urol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.eururo.2012.05.045","article-title":"Systematic review and meta-analysis of studies reporting urinary continence recovery after robot-assisted radical prostatectomy","volume":"62","author":"Ficarra","year":"2012","journal-title":"Eur. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e206359","DOI":"10.1001\/jamasurg.2020.6359","article-title":"Evaluation of Patient- and Surgeon-Specific Variations in Patient-Reported Urinary Outcomes 3 Months After Radical Prostatectomy From a Statewide Improvement Collaborative","volume":"156","author":"Auffenberg","year":"2021","journal-title":"JAMA Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/luts.12308","article-title":"The prevalence of urinary incontinence in men and women aged 40\u2009years or over in China, Taiwan and South Korea: A cross-sectional, prevalence-based study","volume":"12","author":"Sumarsono","year":"2020","journal-title":"Low Urin. Tract Symptoms"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2622","DOI":"10.1016\/j.juro.2009.01.113","article-title":"Temporal trends in adoption of and indications for the artificial urinary sphincter","volume":"181","author":"Lee","year":"2009","journal-title":"J. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Del Giudice, F., Huang, J., Li, S., Sorensen, S., Enemchukwu, E., Maggi, M., Salciccia, S., Ferro, M., Crocetto, F., and Pandolfo, S.D. (Prostate Cancer Prostatic Dis., 2022). Contemporary trends in the surgical management of urinary incontinence after radical prostatectomy in the United States, Prostate Cancer Prostatic Dis., online ahead of print.","DOI":"10.1038\/s41391-022-00558-x"},{"key":"ref_12","first-page":"229","article-title":"Predictive factors of urinary incontinence after radical prostatectomy: Systematic review","volume":"95","author":"Sallami","year":"2017","journal-title":"Tunis. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/S0022-5347(06)00262-X","article-title":"Restoration of posterior aspect of rhabdosphincter shortens continence time after radical retropubic prostatectomy","volume":"175","author":"Rocco","year":"2006","journal-title":"J. Urol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/iju.14609","article-title":"Evaluation of image-based prognostic parameters of post-prostatectomy urinary incontinence: A literature review","volume":"28","author":"Colarieti","year":"2021","journal-title":"Int. J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S1580","DOI":"10.1245\/s10434-015-4847-y","article-title":"A Specific Cystography Pattern Can Predict Postprostatectomy Incontinence","volume":"22","author":"Shao","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","first-page":"278","article-title":"Postoperative cystographic findings as an independent predictor of urinary incontinence three months after radical prostatectomy","volume":"69","author":"Ha","year":"2017","journal-title":"Minerva Urol. Nefrol."},{"key":"ref_17","first-page":"345","article-title":"Retzius-sparing Robotic-assisted Radical Prostatectomy Associated with Less Bladder Neck Descent and Better Early Continence Outcome","volume":"38","author":"Chang","year":"2018","journal-title":"Anticancer Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/21681805.2018.1428683","article-title":"The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy","volume":"52","author":"Sugi","year":"2018","journal-title":"Scand. J. Urol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jfma.2018.04.009","article-title":"Possible predictor of early recovery on urinary continence after laparoscopic radical prostatectomy\u2014Bladder neck level and urodynamic parameters","volume":"118","author":"Huang","year":"2019","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kageyama, S., Yoshida, T., Nagasawa, M., Kubota, S., Tomita, K., Kobayashi, K., Murai, R., Tsuru, T., Hanada, E., and Johnin, K. (2018). The location of the bladder neck in postoperative cystography predicts continence convalescence after radical prostatectomy. BMC Urol., 18.","DOI":"10.1186\/s12894-018-0370-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1111\/luts.12254","article-title":"Postoperative cystogram findings predict recovery of urinary continence after robot-assisted laparoscopic radical prostatectomy","volume":"11","author":"Fukui","year":"2019","journal-title":"Low. Urin. Tract Symptoms"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"234","DOI":"10.5213\/inj.1938072.036","article-title":"The Effectiveness of Cystography-Measured Bladder Neck Elevation at Predicting the Return of Continence After Robot-Assisted Radical Prostatectomy","volume":"23","author":"Huh","year":"2019","journal-title":"Int. Neurourol. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"142","DOI":"10.12701\/yujm.2020.00682","article-title":"Association between cystographic anastomotic urinary leakage following retropubic radical prostatectomy and early urinary incontinence","volume":"38","author":"Kwon","year":"2021","journal-title":"Yeungnam Univ. J. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1177\/0391560320974891","article-title":"Relative position of bladder neck to pubic symphysis on cystogram is a strong and reproducible predictor of early urinary continence recovery following radical prostatectomy","volume":"88","author":"Rossanese","year":"2021","journal-title":"Urologia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1111\/iju.12419","article-title":"Intravesical prostatic protrusion as a predictor of early urinary continence recovery after laparoscopic radical prostatectomy","volume":"21","author":"Lee","year":"2014","journal-title":"Int. J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"E93","DOI":"10.5489\/cuaj.4035","article-title":"Impact of preoperative and postoperative membranous urethral length measured by 3 Tesla magnetic resonance imaging on urinary continence recovery after robotic-assisted radical prostatectomy","volume":"11","author":"Song","year":"2017","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Fukui, S., Kagebayashi, Y., Iemura, Y., Matsumura, Y., and Samma, S. (2019). Preoperative MRI Parameters Predict Urinary Continence after Robot-Assisted Laparoscopic Prostatectomy in Prostatic Cancer Patients. Diagnostics, 9.","DOI":"10.3390\/diagnostics9030102"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.eururo.2008.08.057","article-title":"Recovery of urinary continence after radical prostatectomy: Association with urethral length and urethral fibrosis measured by preoperative and postoperative endorectal magnetic resonance imaging","volume":"55","author":"Paparel","year":"2009","journal-title":"Eur. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.prnil.2018.06.003","article-title":"Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy","volume":"7","author":"Kitamura","year":"2019","journal-title":"Prostate Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1111\/j.1442-2042.2011.02760.x","article-title":"Early recovery of urinary continence after radical prostatectomy: Correlation with vesico-urethral anastomosis location in the pelvic cavity measured by postoperative cystography","volume":"18","author":"Jeong","year":"2011","journal-title":"Int. J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nature21056","article-title":"Dermatologist-level classification of skin cancer with deep neural networks","volume":"542","author":"Esteva","year":"2017","journal-title":"Nature"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.cmpb.2015.12.014","article-title":"Representation learning for mammography mass lesion classification with convolutional neural networks","volume":"127","author":"Arevalo","year":"2016","journal-title":"Comput. Methods Programs Biomed."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"78.e71","DOI":"10.1016\/j.jpurol.2021.10.009","article-title":"A machine learning-based approach for quantitative grading of vesicoureteral reflux from voiding cystourethrograms: Methods and proof of concept","volume":"18","author":"Khondker","year":"2022","journal-title":"J. Pediatr. Urol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Gravina, M., Spirito, L., Celentano, G., Capece, M., Creta, M., Califano, G., Coll\u00e0 Ruvolo, C., Morra, S., Imbriaco, M., and Di Bello, F. (2022). Machine Learning and Clinical-Radiological Characteristics for the Classification of Prostate Cancer in PI-RADS 3 Lesions. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071565"},{"key":"ref_35","first-page":"204","article-title":"Discriminability-Based Transfer between Neural Networks","volume":"5","author":"Pratt","year":"1992","journal-title":"Adv. Neural Inf. Process. Syst."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/126\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:03:08Z","timestamp":1760119388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/1\/126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,8]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jpm13010126"],"URL":"https:\/\/doi.org\/10.3390\/jpm13010126","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,8]]}}}