# An optimized deep learning model based on transperineal ultrasound images for precision diagnosis of female stress urinary incontinence

## TL;DR

A deep learning model using transperineal ultrasound images improves the accuracy of diagnosing female stress urinary incontinence.

## Contribution

An optimized deep learning model (DenseNet-121) for TPUS-based diagnosis of female SUI is developed and validated.

## Key findings

- DenseNet-121 achieved an AUC of 0.869, accuracy of 0.87, and outperformed traditional TPUS-index models.
- The model showed superior diagnostic performance in both training and testing sets compared to conventional methods.

## Abstract

Transperineal ultrasound (TPUS) is widely utilized for the evaluation of female stress urinary incontinence (SUI). However, the diagnostic accuracy of parameters related to urethral mobility and morphology remains limited and requires further optimization.

This study aims to develop and validate an optimized deep learning (DL) model based on TPUS images to improve the precision and reliability of female SUI diagnosis.

This retrospective study analyzed TPUS images from 464 women, including 200 patients with SUI and 264 controls, collected between 2020 and 2024. Three DL models (ResNet-50, ResNet-152, and DenseNet-121) were trained on resting-state and Valsalva-state images using an 8:2 training-to-testing split. Model performance was assessed using diagnostic metrics, including area under the curve (AUC), accuracy, sensitivity, and specificity. A TPUS-index model, constructed using measurement parameters assessing urethral mobility, was used for comparison. Finally, the best-performing DL model was selected to evaluate its diagnostic advantages over traditional methods.

Among the three developed DL models, DenseNet-121 demonstrated the highest diagnostic performance, achieving an AUC of 0.869, an accuracy of 0.87, a sensitivity of 0.872, a specificity of 0.761, a negative predictive value (NPV) of 0.788, and a positive predictive value (PPV) of 0.853. When compared to the TPUS-index model, the DenseNet-121 model exhibited significantly superior diagnostic performance in both the training set (z = −2.088, p = 0.018) and the testing set (z = −1.997, p = 0.046).

This study demonstrates the potential of DL models, particularly DenseNet-121, to enhance the diagnosis of female SUI using TPUS images, providing a reliable and consistent diagnostic tool for clinical practice.