Computed tomography three-dimensional reconstruction in the diagnosis of bleeding small intestinal polyps:A case report

BACKGROUND Computed tomography(CT)small bowel three-dimensional(3D)reconstruction is a powerful tool for the diagnosis of small bowel disease and can clearly show the intestinal lumen and wall as well as the outside structure of the wall.The horizontal axis position can show the best adjacent intestinal tube and the lesion between the intestinal tubes,while the coronal position can show the overall view of the small bowel.The ileal end of the localization of the display of excellent,and easy to quantitative measurement of the affected intestinal segments,the sagittal position for the rectum and the pre-sacral lesions show the best,for the discovery of fistulae is also helpful.Sagittal view can show rectal and presacral lesions and is useful for fistula detection.It is suitable for the assessment of inflammatory bowel disease,such as assessment of disease severity and diagnosis and differential diagnosis of the small bowel and mesenteric space-occupying lesions as well as the judgment of small bowel obstruction points.CASE SUMMARY Bleeding caused by small intestinal polyps is often difficult to diagnose in clinical practice.This study reports a 29-year-old male patient who was admitted to the hospital with black stool and abdominal pain for 3 months.Using the combination of CT-3D reconstruction and capsule endoscopy,the condition was diagnosed correctly,and the polyps were removed using single-balloon enteroscopyendoscopic retrograde cholangiopancreatography without postoperative complications.CONCLUSION The role of CT-3D in gastrointestinal diseases was confirmed.CT-3D can assist in the diagnosis and treatment of gastrointestinal diseases in combination with capsule endoscopy and small intestinal microscopy.

Evaluating the use of three-dimensional reconstruction visualization technology for precise laparoscopic resection in gastroesophageal junction cancer

BACKGROUND Laparoscopic gastrectomy for esophagogastric junction(EGJ)carcinoma enables the removal of the carcinoma at the junction between the stomach and esophagus while preserving the gastric function,thereby providing patients with better treatment outcomes and quality of life.Nonetheless,this surgical technique also presents some challenges and limitations.Therefore,three-dimensional reconstruction visualization technology(3D RVT)has been introduced into the procedure,providing doctors with more comprehensive and intuitive anatomical information that helps with surgical planning,navigation,and outcome evaluation.AIM To discuss the application and advantages of 3D RVT in precise laparoscopic resection of EGJ carcinomas.METHODS Data were obtained from the electronic or paper-based medical records at The First Affiliated Hospital of Hebei North University from January 2020 to June 2022.A total of 120 patients diagnosed with EGJ carcinoma were included in the study.Of these,68 underwent laparoscopic resection after computed tomography(CT)-enhanced scanning and were categorized into the 2D group,whereas 52 underwent laparoscopic resection after CT-enhanced scanning and 3D RVT and were categorized into the 3D group.This study had two outcome measures:the deviation between tumor-related factors(such as maximum tumor diameter and infiltration length)in 3D RVT and clinical reality,and surgical outcome indicators(such as operative time,intraoperative blood loss,number of lymph node dissections,R0 resection rate,postoperative hospital stay,postoperative gas discharge time,drainage tube removal time,and related complications)between the 2D and 3D groups.RESULTS Among patients included in the 3D group,27 had a maximum tumor diameter of less than 3 cm,whereas 25 had a diameter of 3 cm or more.In actual surgical observations,24 had a diameter of less than 3 cm,whereas 28 had a diameter of 3 cm or more.The findings were consistent between the two methods(χ^(2)=0.346,P=0.556),with a kappa consistency coefficient of 0.808.With respect to infiltration length,in the 3D group,23 patients had a length of less than 5 cm,whereas 29 had a length of 5 cm or more.In actual surgical observations,20 cases had a length of less than 5 cm,whereas 32 had a length of 5 cm or more.The findings were consistent between the two methods(χ^(2)=0.357,P=0.550),with a kappa consistency coefficient of 0.486.Pearson correlation analysis showed that the maximum tumor diameter and infiltration length measured using 3D RVT were positively correlated with clinical observations during surgery(r=0.814 and 0.490,both P<0.05).The 3D group had a shorter operative time(157.02±8.38 vs 183.16±23.87),less intraoperative blood loss(83.65±14.22 vs 110.94±22.05),and higher number of lymph node dissections(28.98±2.82 vs 23.56±2.77)and R0 resection rate(80.77%vs 61.64%)than the 2D group.Furthermore,the 3D group had shorter hospital stay[8(8,9)vs 13(14,16)],time to gas passage[3(3,4)vs 4(5,5)],and drainage tube removal time[4(4,5)vs 6(6,7)]than the 2D group.The complication rate was lower in the 3D group(11.54%)than in the 2D group(26.47%)(χ^(2)=4.106,P<0.05).CONCLUSION Using 3D RVT,doctors can gain a more comprehensive and intuitive understanding of the anatomy and related lesions of EGJ carcinomas,thus enabling more accurate surgical planning.

GPU-accelerated three-dimensional reconstruction method of the Compton camera and its application in radionuclide imaging

A novel and fast three-dimensional reconstruction method for a Compton camera and its performance in radionuclide imaging is proposed and analyzed in this study. The conical surface sampling back-projection method with scattering angle correction(CSS-BP-SC) can quickly perform the back-projection process of the Compton cone and can be used to precompute the list-mode maximum likelihood expectation maximization(LM-MLEM). A dedicated parallel architecture was designed for the graphics processing unit acceleration of the back-projection and iteration stage of the CSS-BP-SC-based LM-MLEM. The imaging results of the two-point source Monte Carlo(MC) simulation demonstrate that by analyzing the full width at half maximum along the three coordinate axes, the CSS-BP-SC-based LM-MLEM can obtain imaging results comparable to those of the traditional reconstruction algorithm, that is, the simple back-projection-based LM-MLEM. The imaging results of the mouse phantom MC simulation and experiment demonstrate that the reconstruction results obtained by the proposed method sufficiently coincide with the set radioactivity distribution, and the speed increased by more than 664 times compared to the traditional reconstruction algorithm in the mouse phantom experiment. The proposed method will further advance the imaging applications of Compton cameras.

Survey of methods and principles in three-dimensional reconstruction from two-dimensional medical images

Three-dimensional(3D)reconstruction of human organs has gained attention in recent years due to advances in the Internet and graphics processing units.In the coming years,most patient care will shift toward this new paradigm.However,development of fast and accurate 3D models from medical images or a set of medical scans remains a daunting task due to the number of pre-processing steps involved,most of which are dependent on human expertise.In this review,a survey of pre-processing steps was conducted,and reconstruction techniques for several organs in medical diagnosis were studied.Various methods and principles related to 3D reconstruction were highlighted.The usefulness of 3D reconstruction of organs in medical diagnosis was also highlighted.

Three-dimensional computed tomography reconstruction diagnosed digestive tract perforation and acute peritonitis caused by Monopterus albus:A case report

BACKGROUND Few reports have described living foreign bodies in the human body.The current manuscript demonstrates that computed tomography(CT)is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.The threedimensional(3D)reconstruction technology could clearly display anatomical structures,lesions and adjacent organs,improving diagnostic accuracy and guiding the surgical decision-making process.CASE SUMMARY Herein we describe a 68-year-old man diagnosed with digestive tract perforation and acute peritonitis caused by a foreign body of Monopterus albus.The patient pre-sented to the emergency department with complaints of dull abdominal pain,profuse sweating and a pale complexion during work.A Monopterus albus had entered the patient’s body through the anus two hours ago.During hospitalization,the 3D reconstruction technology revealed a perforation of the middle rectum complicated with acute peritonitis and showed a clear and complete Monopterus albus bone morphology in the abdominal and pelvic cavities,with the Monopterus albus biting the mesentery.Laparoscopic examination detected a large(diameter of about 1.5 cm)perforation in the mid-rectum.It could be seen that a Monopterus albus had completely entered the abdominal cavity and had tightly bitten the mesentery of the small intestine.During the operation,the dead Monopterus albus was taken out.CONCLUSION The current manuscript demonstrates that CT is an effective tool for accurate preoperative evaluation of living foreign bodies in clinic.

Single exposure passive three-dimensional information reconstruction based on an ordinary imaging system

Existing three-dimensional(3D) imaging technologies have issues such as requiring active illumination, multiple exposures, or coding modulation. We propose a passive single 3D imaging method based on an ordinary imaging system.Using the point spread function of the imaging system to realize the non-coding measurement on the target, the full-focus images and depth information of the 3D target can be extracted from a single two-dimensional(2D) image through the compressed sensing algorithm. Simulation and experiments show that this approach can complete passive 3D imaging based on an ordinary imaging system without any coding operations. This method can achieve millimeter-level vertical resolution under single exposure conditions and has the potential for real-time dynamic 3D imaging. It improves the efficiency of 3D information detection, reduces the complexity of the imaging system, and may be of considerable value to the field of computer vision and other related applications.

Image processing based three-dimensional model reconstruction for cross-platform numerical simulation

Numerical simulation is the most powerful computational and analysis tool for a large variety of engineering and physical problems.For a complex problem relating to multi-field,multi-process and multi-scale,different computing tools have to be developed so as to solve particular fields at different scales and for different processes.Therefore,the integration of different types of software is inevitable.However,it is difficult to perform the transfer of the meshes and simulated results among software packages because of the lack of shared data formats or encrypted data formats.An image processing based method for three-dimensional model reconstruction for numerical simulation was proposed,which presents a solution to the integration problem by a series of slice or projection images obtained by the post-processing modules of the numerical simulation software.By means of mapping image pixels to meshes of either finite difference or finite element models,the geometry contour can be extracted to export the stereolithography model.The values of results,represented by color,can be deduced and assigned to the meshes.All the models with data can be directly or indirectly integrated into other software as a continued or new numerical simulation.The three-dimensional reconstruction method has been validated in numerical simulation of castings and case studies were provided in this study.

Multi-Segmental Osteocutaneous Free Fibula Flap for Three-Dimensional Post-Traumatic Thumb and Wrist Reconstruction

Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.

Assessment of Gastric Cancer: Value of Two-phase Multidetector-row Spiral CT Three-dimensional Reconstruction Technique

Abstract Objective： To evaluate the diagnostic value of two-phase multidetector-row spiral CT threedimensional reconstruction technique in TNM staging of gastric cancer. Methods： In 29 patients with gastric carcinoma pathologically conformed, plan scans were done firstly. Two-phase spiral CT was performed within one breathhold each. Distension of the stomach was achieved by intravenous application of anisodamine and effervescent granules. After bolus injection of contrast medium, scanning was performed in the arterial and venous phase, and the source images were thin reconstructed. The stomach to three-dimension analysis was constructed by volume rendering （VR） multiplanaz volume reconstruction （MPVR）, shaded surface display （SSD） and CT virtual gastroscopy （CTVG） technique. In combination with the sources images, gastric tumour invasion and lymph node metastasis was assessed, and TNM staging was performed. Results： In 29 cases of gastric carcinoma, the sensitivity and specificity of two-phase multidetector-row spiral CT three-dimensional reconstruction technique in T1, T2, T3 and Ta staging, the sensitivity and specificity was 50% and 50%, 87.5% and 77.8%, 83.3% and 76.9% and 100% and 80% respectively. For the N staging, the sensitivity and specificity in No, N1, and N2 N3 was 83.3% and 71.4%, 87.5% and 77.8% and 81.8% and 75% respectively. The sensitivity and the specificity for M1 staging was 100%. Conclusion： The reconstruction technique in combination with 16-slices spiral-CT can perform TNM staging well and effectively guide the choice of the surgical procedures for gastric cancer.

A theory for three-dimensional response of micropolar plates

Through combined applications of the transfer-matrix method and asymptotic expansion technique,we formulate a theory to predict the three-dimensional response of micropolar plates.No ad hoc assumptions regarding through-thickness assumptions of the field variables are made,and the governing equations are two-dimensional,with the displacements and microrotations of the mid-plane as the unknowns.Once the deformation of the mid-plane is solved,a three-dimensional micropolar elastic field within the plate is generated,which is exact up to the second order except in the boundary region close to the plate edge.As an illustrative example,the bending of a clamped infinitely long plate caused by a uniformly distributed transverse force is analyzed and discussed in detail.

Oxygen tension modulates cell function in an in vitro three-dimensional glioblastoma tumor model

Hypoxia is a typical feature of the tumor microenvironment,one of the most critical factors affecting cell behavior and tumor progression.However,the lack of tumor models able to precisely emulate natural brain tumor tissue has impeded the study of the effects of hypoxia on the progression and growth of tumor cells.This study reports a three-dimensional(3D)brain tumor model obtained by encapsulating U87MG(U87)cells in a hydrogel containing type I collagen.It also documents the effect of various oxygen concentrations(1%,7%,and 21%)in the culture environment on U87 cell morphology,proliferation,viability,cell cycle,apoptosis rate,and migration.Finally,it compares two-dimensional(2D)and 3D cultures.For comparison purposes,cells cultured in flat culture dishes were used as the control(2D model).Cells cultured in the 3D model proliferated more slowly but had a higher apoptosis rate and proportion of cells in the resting phase(G0 phase)/gap I phase(G1 phase)than those cultured in the 2D model.Besides,the two models yielded significantly different cell morphologies.Finally,hypoxia(e.g.,1%O2)affected cell morphology,slowed cell growth,reduced cell viability,and increased the apoptosis rate in the 3D model.These results indicate that the constructed 3D model is effective for investigating the effects of biological and chemical factors on cell morphology and function,and can be more representative of the tumor microenvironment than 2D culture systems.The developed 3D glioblastoma tumor model is equally applicable to other studies in pharmacology and pathology.

Three-dimensional cell-based strategies for liver regeneration

Liver regeneration and the development of effective therapies for liver failure remain formidable challenges in modern medicine.In recent years,the utilization of 3D cell-based strategies has emerged as a promising approach for addressing these urgent clinical requirements.This review provides a thorough analysis of the application of 3D cell-based approaches to liver regeneration and their potential impact on patients with end-stage liver failure.Here,we discuss various 3D culture models that incorporate hepatocytes and stem cells to restore liver function and ameliorate the consequences of liver failure.Furthermore,we explored the challenges in transitioning these innovative strategies from preclinical studies to clinical applications.The collective insights presented herein highlight the significance of 3D cell-based strategies as a transformative paradigm for liver regeneration and improved patient care.

FPGA-based position reconstruction method for neutron beam flux spatial distribution measurement in BNCT

A new measurement method for the spatial distribution of neutron beam flux in boron neutron capture therapy(BNCT)is being developed based on the two-dimensional Micromegas detector.To address the issue of long processing times in traditional offline position reconstruction methods,this paper proposes a field programmable gate array based online position reconstruction method utilizing the micro-time projection chamber principle.This method encapsulates key technical aspects:a self-adaptive serial link technique built upon the dynamical adjustment of the delay chain length,fast sorting,a coordinate-matching technique based on the mapping between signal timestamps and random access memory(RAM)addresses,and a precise start point-merging technique utilizing a circular combined RAM.The performance test of the selfadaptive serial link shows that the bit error rate of the link is better than 10-12 at a confidence level of 99%,ensuring reliable data transmission.The experiment utilizing the readout electronics and Micromegas detector shows a spatial resolution of approximately 1.4 mm,surpassing the current method’s resolution level of 5 mm.The beam experiment confirms that the readout electronics system can obtain the flux spatial distribution of neutron beams online,thus validating the feasibility of the position reconstruction method.The online position reconstruction method avoids traditional methods,such as bubble sorting and traversal searching,simplifies the design of the logic firmware,and reduces the time complexity from O(n2)to O(n).This study contributes to the advancement in measuring neutron beam flux for BNCT.

Predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction

BACKGROUND Meniscus extrusion occurs in most elderly individuals and most patients after meniscus allograft transplantation.The risk factors and correlative factors of meniscus extrusion have been extensively studied.However,for using tendon autograft for meniscus reconstruction,both graft type and surgical method are different from those in previous studies on meniscus extrusion.AIM To identify predictive factors for coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.METHODS Ten patients who underwent medial meniscus reconstruction with tendon autograft were selected for this retrospective observational study.The graft extrusions and potential factors were measured and correlation and regression analyses were performed to analyze their relationships.RESULTS The medial graft extrusion correlated with the preoperative bilateral hip-kneeankle angle difference,preoperative Kellgren-Lawrence grade,preoperative relative joint space width,and preoperative bilateral medial edge incline angle difference.The anterior graft correlated with the anterior tunnel edge distance at 1 week after operation.The posterior graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference,preoperative relative joint space width,and posterior tunnel edge distance at 1 week after operation.The mean graft extrusion correlated with the preoperative bilateral hip-knee-ankle angle difference and preoperative relative joint space width.The preoperative joint space width and anterior and posterior tunnel edge distance at 1 week can be used to predict the medial,anterior,posterior,and mean graft extrusion length.CONCLUSION The preoperative joint space width and tunnel position can be used to predict the coronal and sagittal graft extrusion length after using tendon autograft for medial meniscus reconstruction.

Reactor field reconstruction from sparse and movable sensors using Voronoi tessellation-assisted convolutional neural networks

The aging of operational reactors leads to increased mechanical vibrations in the reactor interior.The vibration of the incore sensors near their nominal locations is a new problem for neutronic field reconstruction.Current field-reconstruction methods fail to handle spatially moving sensors.In this study,we propose a Voronoi tessellation technique in combination with convolutional neural networks to handle this challenge.Observations from movable in-core sensors were projected onto the same global field structure using Voronoi tessellation,holding the magnitude and location information of the sensors.General convolutional neural networks were used to learn maps from observations to the global field.The proposed method reconstructed multi-physics fields(including fast flux,thermal flux,and power rate)using observations from a single field(such as thermal flux).Numerical tests based on the IAEA benchmark demonstrated the potential of the proposed method in practical engineering applications,particularly within an amplitude of 5 cm around the nominal locations,which led to average relative errors below 5% and 10% in the L_(2) and L_(∞)norms,respectively.

Sparse Modal Decomposition Method Addressing Underdetermined Vortex-Induced Vibration Reconstruction Problem for Marine Risers

When investigating the vortex-induced vibration(VIV)of marine risers,extrapolating the dynamic response on the entire length based on limited sensor measurements is a crucial step in both laboratory experiments and fatigue monitoring of real risers.The problem is conventionally solved using the modal decomposition method,based on the principle that the response can be approximated by a weighted sum of limited vibration modes.However,the method is not valid when the problem is underdetermined,i.e.,the number of unknown mode weights is more than the number of known measurements.This study proposed a sparse modal decomposition method based on the compressed sensing theory and the Compressive Sampling Matching Pursuit(Co Sa MP)algorithm,exploiting the sparsity of VIV in the modal space.In the validation study based on high-order VIV experiment data,the proposed method successfully reconstructed the response using only seven acceleration measurements when the conventional methods failed.A primary advantage of the proposed method is that it offers a completely data-driven approach for the underdetermined VIV reconstruction problem,which is more favorable than existing model-dependent solutions for many practical applications such as riser structural health monitoring.

The combined application of stem cells and three-dimensional bioprinting scaffolds for the repair of spinal cord injury

Spinal cord injury is considered one of the most difficult injuries to repair and has one of the worst prognoses for injuries to the nervous system.Following surgery,the poor regenerative capacity of nerve cells and the generation of new scars can make it very difficult for the impaired nervous system to restore its neural functionality.Traditional treatments can only alleviate secondary injuries but cannot fundamentally repair the spinal cord.Consequently,there is a critical need to develop new treatments to promote functional repair after spinal cord injury.Over recent years,there have been seve ral developments in the use of stem cell therapy for the treatment of spinal cord injury.Alongside significant developments in the field of tissue engineering,three-dimensional bioprinting technology has become a hot research topic due to its ability to accurately print complex structures.This led to the loading of three-dimensional bioprinting scaffolds which provided precise cell localization.These three-dimensional bioprinting scaffolds co uld repair damaged neural circuits and had the potential to repair the damaged spinal cord.In this review,we discuss the mechanisms underlying simple stem cell therapy,the application of different types of stem cells for the treatment of spinal cord injury,and the different manufa cturing methods for three-dimensional bioprinting scaffolds.In particular,we focus on the development of three-dimensional bioprinting scaffolds for the treatment of spinal cord injury.

Estimation-free spatial-domain image reconstruction of structured illumination microscopy

Structured illumination microscopy(SIM)achieves super-resolution(SR)by modulating the high-frequency information of the sample into the passband of the optical system and subsequent image reconstruction.The traditional Wiener-filtering-based reconstruction algorithm operates in the Fourier domain,it requires prior knowledge of the sinusoidal illumination patterns which makes the time-consuming procedure of parameter estimation to raw datasets necessary,besides,the parameter estimation is sensitive to noise or aberration-induced pattern distortion which leads to reconstruction artifacts.Here,we propose a spatial-domain image reconstruction method that does not require parameter estimation but calculates patterns from raw datasets,and a reconstructed image can be obtained just by calculating the spatial covariance of differential calculated patterns and differential filtered datasets(the notch filtering operation is performed to the raw datasets for attenuating and compensating the optical transfer function(OTF)).Experiments on reconstructing raw datasets including nonbiological,biological,and simulated samples demonstrate that our method has SR capability,high reconstruction speed,and high robustness to aberration and noise.

In vitro performance of a biodegradable zinc alloy adjustable-loop cortical suspension fixation for anterior cruciate ligament reconstruction

Anterior cruciate ligament(ACL)injuries of the knee are one of the most common and serious athletic injuries.The widely used cortical suspension fixation buttons for ligament reconstruction are permanent implants,particularly those made from conventional steel or titanium alloys.In this study,a biodegradable Zn-0.45Mn-0.2Mg(ZMM42)alloy with the yield strength of 300.4 MPa and tensile strength of 329.8 MPa was prepared through hot extrusion.The use of zinc alloys in the preparation of cortical suspension fixation buttons was proposed for the first time.After 35 d of immersion in simulated body fluids,the ZMM42 alloy fixation buttons were degraded at a rate of 44μm/a,and the fixation strength was retained(379.55 N)in the traction loops.Simultaneously,the ZMM42 alloy fixation buttons exhibited an increase in MC3T3-E1 cell viability and high antibacterial activity against Escherichia coli and Staphylococcus aureus.These results reveal the potential of biodegradable zinc alloys for use as ligament reconstruction materials and for developing diverse zinc alloy cortical suspension fixation devices.

Summarizing the evidence for robotic-assisted bladder neck reconstruction: Systematic review of patency and incontinence outcomes

Objective:Bladder neck contracture and vesicourethral anastomotic stenosis are difficult to manage endoscopically,and open repair is associated with high rates of incontinence.In recent years,there have been increasing reports of robotic-assisted bladder neck reconstruction in the literature.However,existing studies are small,heterogeneous case series.The objective of this study was to perform a systematic review of robotic-assisted bladder neck reconstruction to better evaluate patency and incontinence outcomes.Methods:We performed a systematic review of PubMed from first available date to May 2023 for all studies evaluating robotic-assisted reconstructive surgery of the bladder neck in adult men.Articles in non-English,author replies,editorials,pediatric-based studies,and reviews were excluded.Outcomes of interest were patency and incontinence rates,which were pooled when appropriate.Results:After identifying 158 articles on initial search,we included only ten studies that fit all aforementioned criteria for robotic-assisted bladder neck reconstruction.All were case series published from March 2018 to March 2022 ranging from six to 32 men,with the median follow-up of 5e23 months.A total of 119 patients were included in our analysis.A variety of etiologies and surgical techniques were described.Patency rates ranged from 50%to 100%,and pooled patency was 80%(95/119).De novo incontinence rates ranged from 0%to 33%,and pooled incontinence was 17%(8/47).Our findings were limited by small sample sizes,relatively short follow-ups,and heterogeneity between studies.