Combination of deep learning and ensemble machine learning using
intraoperative video images strongly predicts recovery of urinary
continence after robot-assisted radical prostatectomy.
Abstract
Objectives: We recently reported that deep learning (DL) using
pelvic magnetic resonance imaging is useful for predicting the severity
of urinary incontinence (UI) after robot-assisted radical prostatectomy
(RARP). However, our results were limited because the prediction
accuracy was approximately 70%. We aimed to develop a more accurate
prediction system that can be used to inform patients on recovery from
UI after RARP using a DL model based on intraoperative video images.
Materials and Methods: This study included 101 patients with
prostate cancer who underwent RARP. Three snapshots showing the pelvic
cavity (before bladder neck incision, just after prostate removal, and
after vesicourethral anastomosis) from intraoperative video records, as
well as preoperative and intraoperative covariates, were assessed. We
evaluated the DL models plus simple or ensemble machine learning, and
their sensitivity, specificity, and area under the receiver operating
characteristic curve (AUC) were analyzed. Results: Sixty-four
and 37 patients demonstrated ‘early continence’ and ‘late continence’,
respectively, at the 3-month follow-up. The combination of DL and simple
machine learning using intraoperative video snapshots with
clinicopathological parameters had a notably high performance (AUC,
0.683 to 0.749) for predicting early recovery from post-prostatectomy
UI. Notably, the combination of DL and ensemble artificial neural
network using intraoperative video snapshots had the highest performance
(AUC, 0.882; sensitivity, 92.2%; specificity, 78.4%; overall accuracy,
85.3%) for predicting early recovery from post-prostatectomy UI. In
contrast, DL and ensemble ML with clinicopathological parameters (Method
4) achieved no additive effects (AUC, 0.690 to 0.747) compared with DL
and simple ML with clinicopathological parameters. Internal validation
was performed on additional 30 cases with similar results.
Conclusions: Our results suggest that DL algorithms using
intraoperative video images can be used to reliably inform patients
regarding their recovery from UI after RARP. (287 words)