Background Hypospadias remains the most prevalent congenital abnormality in boys worldwide. However, the limited infrastructure and number of pediatric urologists capable of diagnosing and managing the condition hinder the management of hypospadias in Indonesia. The use of artificial intelligence and image recognition is thought to be beneficial in improving the management of hypospadias cases in Indonesia. Objective We aim to develop and validate a digital pattern recognition system and a mobile app based on an artificial neural network to determine various parameters of hypospadias. Methods Hypospadias and normal penis images from an age-matched database will be used to train the artificial neural network. Images of 3 aspects of the penis (ventral, dorsal, and lateral aspects, which include the glans, shaft, and scrotum) will be taken from each participant. The images will be labeled with the following hypospadias parameters: hypospadias status, meatal location, meatal shape, the quality of the urethral plate, glans diameter, and glans shape. The data will be uploaded to train the image recognition model. Intrarater and interrater analyses will be performed, using the test images provided to the algorithm. Results Our study is at the protocol development stage. A preliminary study regarding the system’s development and feasibility will start in December 2022. The results of our study are expected to be available by the end of 2023. Conclusions A digital pattern recognition system using an artificial neural network will be developed and designed to improve the diagnosis and management of patients with hypospadias, especially those residing in regions with limited infrastructure and health personnel. International Registered Report Identifier (IRRID) PRR1-10.2196/42853

https://jmir.org/api/download?alt_name=resprot_v11i11e42853_app1.pdf&filename=be7027e472a355a40fb8ba96fd5723b9.pdf

Digital Pattern Recognition for the Identification of Various Hypospadias Parameters via an Artificial Neural Network: Protocol for the Development and Validation of a System and Mobile App

INTRODUCTION
Uroflowmetry is a noninvasive measurement of the volume of urine excreted over time. Conventional uroflowmetry has become the main modality of urine flow measurement within time. However, this method requires the patient to be present in the hospital or healthcare setting, thus sometimes making the patients feel uncomfortable to undergo the examination. This led to multiple measurements which are inconvenient for the patients. Mobile acoustic uroflowmetry (sono-uroflowmetry) has been proposed as an alternative method of urine flow measurement due to its portability. This study aimed to evaluate the accuracy and reliability of sono-uroflowmetry as compared to conventional uroflowmetry.


METHODS
Electronic databases searching were done using prespecified search strategy to retrieve articles related with uroflowmetry. In addition, hand-search strategy was used to identify additional articles. Studies with participants who had undergone sono-uroflowmetry were included. Voided volume, voiding duration, maximum flow rate, and average flow rate were identified and used to determine the outcomes of measurement. The quality of included articles was conducted using checklist for Diagnostic Test Accuracy Studies by JBI.


RESULTS
Initial search yielded 335 articles with four additional papers identified through hand-searching process. Six papers were retrieved and further used in the narrative synthesis. Five studies enrolled male participants, while only one of the papers enrolled female participants as additional subgroup analysis. Therefore, the meta-analysis was performed by using only male participants. Based on the meta-analysis results, there were strong to very strong positive correlation in voided volume, voiding time, average flow, average flow rate, and maximum flow rate between sono and conventional uroflowmetry.


CONCLUSION
Sonouroflowmetry showed significant positive correlations to conventional uroflowmetry, signifying its use as an alternative of conventional uroflowmetry.

Comparative study of mobile acoustic uroflowmetry and conventional uroflowmetry: A systematic review and meta analysis.

Covid-19 Epidemic has significantly changed how hypospadias patients are delivered to healthcare services, particularly after hypospadias repairs (postoperative care). Some studies reported that using telemedicine schemes by sending digital documentation such as images and videos through cell phones can facilitate an assessment of postoperative monitoring of hypospadias patients. However, this approach raises various concerns, such as managing digital documentation of hypospadias patients, analyzing the data, and the security of individuals' health information. This study proposes a design of cloud-based architecture for early detection and postoperative monitoring of hypospadias patients to address the concerns above. The user acceptance test shows that most users agree that this application may be used for early detection, monitoring hypospadias patients, and helping capture videos and provide labeling to patients' data.

Cloud-Based Architecture for Early Detection and Postoperative Monitoring of Hypospadias Patients in Indonesia

Covid-19 Epidemic has significantly changed how hypospadias patients are delivered to healthcare services, particularly after hypospadias repairs (postoperative care). Some studies reported that using telemedicine schemes by sending digital documentation such as images and videos through cell phones can facilitate an assessment of postoperative monitoring of hypospadias patients. However, this approach raises various concerns, such as managing digital documentation of hypospadias patients, analyzing the data, and the security of individuals' health information. This study proposes a design of cloud-based architecture for early detection and postoperative monitoring of hypospadias patients to address the concerns above. The user acceptance test shows that most users agree that this application may be used for early detection, monitoring hypospadias patients, and helping capture videos and provide labeling to patients' data. 

The Use of Uroflowmetry as a Diagnostic Test

Purpose To investigate the validity and reliability of a home-based, guardian-conducted video voiding test for assessing postoperative voiding function after hypospadias surgery. Materials and Methods In a single center, patients who had undergone urethroplasty by a single surgeon and postoperative uroflowmetry and video voiding tests conducted between 2008 and 2016 were retrospectively reviewed. Urinary stream was categorized into five grades by three pediatric urologists in a blinded manner. The primary outcome was statistical correlation across raters as measured by Spearman correlation coefficient to validate the interpretation of the video voiding test. The secondary outcome was the reliability of the voiding video test compared with maximum urinary flow rate assessed by uroflowmetry. Results Thirty-one patients with hypospadias were enrolled. The patients' average ages were 12.3±3.2 months (range, 8-21 months) and 42.8±3.9 months (range, 35-48 months) at the time of surgery and voiding video tests, respectively. Hypospadias was anterior, penile, and proximal in 1 (3.2%), 18 (58.1%), and 12 (38.7%) patients, respectively. The number of patients with each voiding stream grade was as follows: very poor, 4; poor, 4; fair, 13; good, 4; and very good, 6. All intraclass correlation coefficients of the stream grade among the three observers were >0.95. Correlation between the maximum flow rate obtained by use of conventional uroflowmetry and the video voiding stream grade was validated (rho 0.778, p<0.001). Conclusions The home-based guardian-conducted video voiding test is easy to perform and the present results demonstrate its validity and reliability for assessing patients' post-urethroplasty voiding pattern.

https://icurology.org/pdf/10.4111/icu.2020.61.4.425

Validity and reliability of a home-based, guardian-conducted video voiding test for voiding evaluation after hypospadias surgery.

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Validity and reliability of a home-based, guardian-conducted video voiding test for voiding evaluation after hypospadias surgery.