Despite improved surgical techniques, the reported rate of positive surgical margins (PSM) after robotic-assisted laparoscopic prostatectomy remains as high as 20-40%. These PSM are associated with disease progression after surgery and should be avoided. Currently, there is no technique available to detect PSM intraoperatively. Diffuse Reflectance Spectroscopy (DRS) is proposed as a technique to detect tumor tissue at the surgical resection margin, intraoperatively. Over 800 measurements were performed on the prostate surface and, to mimic a PSM, on the cleaved prostate surface. A machine learning-based classification model was able to discriminate healthy tissue from tumor tissue with sufficient accuracy.

Microsurgical testicular sperm extraction (micro-TESE) is a surgical procedure that extracts sperm directly from testicular tissue for patients suffering from non-obstructive azoospermia (NOA). A more accurate and non-invasive visualization method is needed for assisting surgeons to increase the success rate and decrease the damage to patients. In this study, we developed a customized spectrum domain optical coherence tomography(SD-OCT) system for visualization of sperm within seminiferous tubules in NOA rat model. Our results show a 92.78% for detection of pockets of sperm, demonstrating the potential for the use of OCT for improved guidance in micro-TESE.

As a multimodal approach, optical coherence tomography (OCT) and Raman spectroscopy (RS) are combined. The acquired morpho-molecular tissue information is not only used for improved clinical diagnostics, but furthermore for investigation, interpretation and understanding of signal origin during ex-vivo as well as in-vivo investigation. We present co-localized, endoscopically acquired OCT and RS data on bladder cancer biopsies. Ground truth is histopathological examination. These findings contribute to interpretation of in-vivo data acquired with endoscopic imaging systems. This approach not only opens a new way of interpretation of both modalities but enables access to clinical relevant information, which is nowadays not available in-situ.

Transperineal laser ablation (TPLA) is a novel minimal invasive treatment of benign prostatic obstruction. TPLA can be performed in an outpatient setting under local anesthesia with optional conscious sedation. The mechanism is based on laser ablation resulting in coagulative necrosis, which is induced by the laser light of 1064 nm. Laser light is delivered in the prostate trough transperineal placed needles. This study treated 20 men using TPLA to evaluate safety, feasibility, and voiding outcomes. TPLA has the potential to become an alternative for standard treatments with urethral approach that require general or spinal anesthesia and hospital admittance.

This conference presentation was prepared for the Advanced Photonics in Urology 2023 conference at SPIE BiOS, SPIE Photonics West 2023.

Blue light cystoscopy (BLC) and white light cystoscopy (WLC) are standard of care tools to image the bladder for suspicious areas of tumor development. Having clear, high-quality frames in cystoscopy videos are crucial to sensitive, efficient detection of bladder tumors. Vessel features carry rich information but are often lost or poorly visualized in frames containing illumination artifacts or impacted by impurities in the bladder. In our study, we introduced an automatic WLC and BLC classification method for cystoscopy video analysis and proposed an image enhancement pipeline that addresses the loss of features for cystoscopy videos containing WLC and BLC frames.

With OCT, for the first time, the urothelial thickness change induced by water transport was observed in situ under OCT. The percentage of the change is proportional to the osmolarity of the NaCl applied to the urothelium, and different degrees of damage can be observed in histology and SEM. The observation may reveal the etiology of some highly prevalent diseases, such as interstitial cystitis/bladder pain syndrome (IC/BPS) and overactive bladder (OAB).

Percutaneous nephrostomy (PCN) is a minimally invasive procedure used in kidney surgery. PCN needle placement is of great importance for the following successful renal surgery. In this study, we designed and built an endoscopic polarization-sensitive optical coherence tomography (PS-OCT) system for the PCN needle guidance. Compared to traditional OCT, PS-OCT will allow more accurate differentiation of the renal tissue types in front of the needle. In the experiment, we imaged different renal tissues from human kidneys using the PS-OCT endoscope. Furthermore, deep learning methods were applied for automatic recognition of different tissue types.

White light cystoscopy is key to inform care of patients with suspected or confirmed bladder cancer. Although three-dimensional reconstructions of cystoscopy videos can facilitate rapid, comprehensive review, they are limited by the quality of the original video. Here we address a fundamental bottleneck to reconstruction quality: real-time assessment of frame quality for eventual clinician guidance. We implemented nine metrics and combined them with a random forest classifier that achieves a sensitivity and specificity of 90.6% and 93.7%, respectively. We will use this classifier to perform real-time clinician guidance to facilitate acquisition of high-quality cystoscopy videos that produce robust three-dimensional reconstructions.

Transperineal focal laser ablation (TPLA) has the potential to obtain oncological control, while sparing nearby tissue to preserve continence and erectile function with a low toxicity profile. However, registration and prediction of the ablation zone is essential for TPLA to become a clinal standard of care treatment. In this study we investigated the capability of MRI and CEUS to image the treated volume. We show that the treatment effects of TPLA can reliably be visualized using these techniques and that the results are in good agreement with histopathology. These results are essential first steps towards improved planning and performance of TPLA.