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In this article, a fourth-order finite-difference ghost-point method for the Poisson equation on regular Cartesian mesh is presented. The method can be considered the high-order extension of the second-order ghost method introduced earlier by the authors. Three different discretizations are considered, which differ in the stencil that discretizes the Laplacian and the source term. It is shown that only two of them provide a stable method. The accuracy of such stable methods is numerically verified on several test problems.

We classify hypersurfaces with rotational symmetry and positive constant r-th mean curvature in Hn×R ${\mathbb{H}}^{n}{\times}\mathbb{R}$ . Specific constant higher order mean curvature hypersurfaces invariant under hyperbolic translation are also treated. Some of these invariant hypersurfaces are employed as barriers to prove a Ros–Rosenberg type theorem in Hn×R ${\mathbb{H}}^{n}{\times}\mathbb{R}$ : we show that compact connected hypersurfaces of constant r-th mean curvature embedded in Hn×[0,∞) ${\mathbb{H}}^{n}{\times}\left[0,\infty \right)$ with boundary in the slice Hn×{0} ${\mathbb{H}}^{n}{\times}\left\{0\right\}$ are topological disks under suitable assumptions.

Sectors of the Campania region (southern Italy), where pyroclastic airfall deposits cover carbonate slopes, have frequently experienced debris avalanches and debris flows. These landslides are triggered by heavy rainfall and in the last century caused severe destruction and hundreds of deaths. Their occurrence is controlled by the interaction of several factors, both natural and human induced. The initial failure is linked with the presence of morphological discontinuities such as rocky scarps and road cuts, which interrupt the stratigraphical continuity of an “infinite slope”. Here the main criteria for susceptibility analysis are defined trying to develop a procedure for identify highly-susceptible sources, runout and invasion areas.

An experimental investigation on the durability of Lightweight Cemented Soils (LWCS) after wetting and drying cycles was developed, focusing on the evolution of their mechanical response. Wetting and drying cycles were performed in climatic chamber to test their mechanical performance as function of number of cycles and the environmental conditions (50% and 90% of Relative Humidity). Unconfined compression tests and triaxial tests were performed on treated specimens after cycles in dry state. Suction of LWCS samples was measured after mechanical tests. Test results show that the wetting-drying cycles and the variations of suction are responsible for the evolution of LWCS mechanical behaviour. Moreover, strength and stiffness of the treated samples are related to the suction level induced by environmental conditions. The degradation of mechanical behaviour is linked to the number of cycles and to the amplitude of suction variation induced, being the latter responsible for mechanical cement bonding destructuration.

A geotechnical monitoring campaign and a site investigation have been recently planned and undertaken aiming at the preservation and protection of the “Palazzone” Etruscan necropolis, an archaeological site dated back to Hellenistic period located 4 km from the city of Perugia, along the southeastern margin of the hill where the town is settled. The site includes some beautiful and monumental cavities, among them, the Volumni Hypogeum. The majority of the graves are underground cavities excavated in partially saturated alluvial soil deposits. Their inspection reveals the geological features and the depositional structures. The groundwater table is located about 35 m below the ground surface. Due to the difficulties of soil-sampling inside the ancient cavities, only limited portions of the material were retrieved for conventional laboratory tests, although not enough for a geotechnical characterization. On the other hand, XRD analyses and MIP tests were performed. The obtained results allowed to recognize the relevant contribution of soil suction to the stability conditions of the lateral walls and the ceiling of the cavities, which is complementary to the weak cementation characterizing the soil mass. This important information supports the conservation strategy of the monument, which has as its primary tool the monitoring of environmental conditions, aimed at maintaining the unsaturated conditions of the soil mass.

In museums, poor indoor air quality combined with unsuitable thermal and hygrometric conditions can affect the visitors and staff wellbeing as well as cause the deterioration processes of the exhibit objects. In order to assess indoor air quality of the museum, a survey was carried out in some rooms of the Uffizi Gallery of Florence by the researchers of the Laboratory of Environmental Physics of the University of Florence. Indoor temperature, relative humidity, chemical and microbiological pollutants were sampled, and the results analyzed and discussed. To do that a general methodology of investigation and evaluation of the results was defined and applied to several rooms of the Gallery. The presence of critical pollutant concentration was underlined and proper investigations on the HVAC system were scheduled. In this paper the results regarding a representative room are shown and discussed.

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The strategies adopted in the experimental campaigns performed at INFN - Laboratori Nazionali del Sud are briefly described, emphasizing the advantages of the multi-channel approach to nuclear reaction data analysis.

In soil stabilisation, the use of alternative products to lime or cement has been proposed. However, the effects of these additives, of various origins, on soil behaviour and stabilizing mechanisms are not well understood. Thus, the aim of this paper is to characterize the modification of the mechanical behaviour and microstructure of two soils after treatment with one of those product, a vinyl based copolymer. After treatment, both materials were compacted up to their maximum dry density. The mechanical behaviour of the materials as a function of the curing conditions, suction and water content was first determined. In a second step, the alteration of the microstructure by the treatment product was assessed. The results showed that the treatment permitted to significantly improve the strength of the tested soils. Moreover, the efficiency of the product increases when the soil is dried. However, the Young modulus is not significantly modified by the treatment. Microstructural reorganization after co-polymer addition has been detected by SEM technique for kaolin samples, whereas no modification have been observed for silt samples.

The geotechnical construction industry is a major component of the overall construction sector and is strategically important in infrastructure development (transportation, flood and landslide protection, building foundations, waste disposal). Although industry and research in the overall construction sector have been investing significantly in recent years to produce innovative low-carbon technologies, little innovation has been created in geotechnical construction industry, which is lagging behind other construction industry sectors. This paper discusses the interplay between low-carbon geotechnical engineering and unsaturated soil mechanics based on the research carried out within the project TERRE (Marie Skłodowska-Curie Innovative Training Networks funded by the European Commission, 2015-2019,H2020-MSCA-ITN-2015-675762).

An experimental investigation on the mechanical improvement induced by alkali-activated binder based on the activation of a fluidal bed combustion fly ash on a clayey soil has been developed. The use of these binders for geotechnical applications is a promising issue in terms of sustainability since it reduces the carbon footprint and allows reusing secondary by-products such as artificial pozzolans. Treated samples were prepared by mixing soil and fly ash with water and alkaline solution and dynamically compacted. Mechanical behaviour has been investigated by means of triaxial tests performed on treated samples compacted at optimum water content. Addition of alkali activated binder increased stiffness and shear strength of treated samples, whose extent depends on binder content and curing time. Macroscopic behaviour of treated soil has been linked to the experimental evidences at microscale. Microstructural analyses highlighted a high reactivity of alkali-activated fly ashes as alumino-silicate source promoting the precipitation of new mineralogical phases with cementitious properties. Amorphous alumino-silicate gels produced from alkali-activation of fly ash bound particles aggregates leading to a decrease of cumulative pore volume and porosity of treated samples and modification of the modal pore size.

In the present paper an experimental investigation on water retention properties of lightweight cemented soils (LWCS) taking into account the effects of air foam content and curing time is presented. This experimental study, aimed at determining the suction range corresponding to significant changes in water content, is preliminary to future investigations devoted to durability properties of LWCS systems against wetting and drying cycles. Test results showed that water retention capacity is slightly affected by the curing time for the considered time interval (i.e. 30 and 90 days). Furthermore, the addition of air foam does not affect water retention properties of treated samples. Large voids are present in the samples as footprints of air bubbles added upon mixing, leading to an increase of the porosity of samples without altering the microstructure of the matrix.

Energy piles are an innovative technology that couples the role of the structural foundation to the role of the heat exchanger to satisfy the energy needs of buildings and infrastructures. In the last decade insight into the mechanisms governing the thermo-mechanical response of single energy piles have been gained via full-scale in-situ tests, numerical analyses and model-scale experiments. The numerical approaches allow testing a large variety of configurations, geometries, materials, thermo-mechanical loadings and boundary conditions in a rather controlled but relatively easy and cost-effective manner. As a widespread habit it should be remarked that the temperature changes adopted in the piles have been only rarely justified based on realistic heating and cooling demands of live buildings. This numerical study investigates the effects of combination of mechanical and thermal loads on the mechanical behaviour of a single energy pile embedded in a typical pyroclastic soil deposit of Campania region, in Southern Italy. Thermal loads over one year have been determined by means of Design Builder software analysing a building in Napoli; the intermittent operation of the heat pump over daily time scale is properly modelled in the coupled thermo-hydro-mechanical axisymmetric FE analyses. A sensitivity analysis has been carried out to investigate the effects of the surface thermal boundary conditions.

One of the main problems encountered in civil engineering is the management of large amounts of excavated soil, especially when the mechanical properties of this soil are not suitable for its reuse as a construction material. However, the excavated soil could represent a resource if appropriately improved. A suitable solution is the addition of cement and foam to produce lightweight cemented soils (LWCS). In this paper, an insight into the influence of foam on chemo-mineralogical and microstructural features of soil-cement-water system is presented. Time dependent mineralogical and microstructural changes have been monitored by means of X-Ray Diffraction, Thermo-gravimetric analysis and Mercury Intrusion Porosimetry. The present study shows that addition of foam does not alter the chemo-physical evolution of the soil-cement-water system. Large voids are present in the samples as footprint of air bubbles upon mixing, thus increasing porosity. Macroscopic behaviour of treated samples has been investigated by direct shear and oedometric tests. Chemo-physical evolution induced by cement addition is the major responsible for mechanical improvement showed by treated samples. Porosity of samples induced by foam addition plays a key role in the mechanical response of LWCS, inducing a transition of stress-strain behaviour from brittle and dilative to ductile and contractive as a function of increasing foam content.

In the present paper, the use of alkali activated binders to improve engineering properties of clayey soils is presented as an alternative to traditional binders such as lime or cement. An alkali-activated fly ash and its chemo-physical evolution has been monitored at increasing curing times by means of X-Ray Diffraction and Scanning Electron Microscopy. Alkali-activated binder has been mixed with soil for evaluating the improvement of its mechanical behaviour. One-dimensional compression tests on treated samples have been performed with particular reference to effects induced by binder content and curing time. Test results showed a high initial reactivity of the alkali activated systems promoting formation of new mineralogical phases responsible of the mechanical improvement of the treated soil.

The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay half-life. The methodology of the experimental campaign presently running at INFN - Laboratori Nazionali del Sud is reported andthe experimental challenges characterizing such activity are described.

INTRODUCTION: la fistule obstétricale est un orifice entre le vagin et la vessie ou le rectum, voire les deux. Ses impacts sont des conséquences anatomo-fonctionnelles et sociales. On estime à plus de 19 000 le nombre de femmes qui souffrent de fistule obstétricale au Cameroun. METHODES: il s'agissait d'une étude transversale descriptive conduite dans trois districts de santé de la région de l'Extrême-nord. Vingt-huit femmes victimes de fistules obstétricales, quarante-deux membres de leur entourage et vingt-quatre agents de santé ont été interviewés entre Novembre et Décembre 2013. Trois types de questionnaires ont été utilisés. Les données ont été analysées dans Epi Info version 7.1.4.0. Les moyennes et les fréquences ont été calculées avec un intervalle de confiance à 95%. RESULTATS: 46,4% des femmes victimes de fistule obstétricales interviewées avaient subi une intervention chirurgicale réparatrice parmi lesquelles, 61,5% bénéficiaient de la réintégration. Le fonds de commerce (62,5%) était l'aide la plus reçue. Vingt-deux membres de l'entourage savaient pourquoi on fait la réintégration. Selon eux, les considérations socioculturelles (68,2%), sont la principale barrière de la réintégration. D'après les agents de santé, le suivi psychosocial (58,3%) est la principale activité de la réintégration dans les centres de prise en charge de la fistule. CONCLUSION: la prise en charge des fistules obstétricales au Cameroun souffre de manque de réintégration sociale. Ceci expliquerait en partie la persistance de cette pathologie. Un accent devrait être mis sur l'appui matériel, financier et sur le suivi psychosocial des femmes victimes de fistule obstétricale.

The paper presents and discusses some results of an experimental research aimed at analysing the influence of compaction variables (w and energy) and method on the resulting microstructure of a compacted silty soil. In particular, the experimental data here discussed allow to compare the microstructure induced by different dynamic compaction techniques, comparing that characterising specimens obtained by two laboratory methods (Proctor standard and Harvard) and that of samples compacted in-situ during the construction of an embankment built for river regimentation purposes. Both undisturbed and disturbed samples have been retrieved from the embankment, the latter one with the purpose of collecting the soil subsequently used for laboratory compaction. Microstructural analyses (SEM, MIP) performed on laboratory and in-situ compacted samples evidenced a substantial similarity of the texture induced by the various compaction techniques, highlighting that laboratory compaction is suitable to provide soil samples representative of earth in-situ compacted soil.

In the paper some results on the effects of chemo-physical evolution of clay-lime-water suspensions on the microstructure of a lime treated kaolin have been presented. A multi-scale investigation on the sedimentation behaviour of clay suspensions under different pore water chemistry has been developed highlighting the chemo-physical mechanisms controlling particle arrangement and the soil fabric formation. The results evidenced the key role of ionic exchange in the short term on the microstructure features of the lime treated soil.

Erectile Dysfunction (ED) is defined as the persistent inability to obtain and maintain an erection that enables satisfactory sexual intercourse. ED prevalence vary across age groups, affecting approximately 1-9% of men under 40, 2-9% of those aged 40-59, and increasing to 20-40% for those aged 60-69. However, it remains a frequently untreated or insufficiently treated condition. Especially due to the feeling of discomfort and guilt, patients often avoid consulting their physicians; in this context, digital innovation could potentially play a pivotal role in the diagnosis and management of ED. This narrative review depicts the ongoing status of digital innovations in ED focusing on websites, social media platforms and mobile health applications (MHA). We examined Google, social media platforms (Facebook, Twitter, YouTube, and TikTok), and the recently developed MHA apps on Google Play Store and Apple App Store. Websites provide readily available but sometimes difficult to understand information, while social media is easy to understand and act on. MHA apps are the most complete and trustworthy tool for self-care management. In conclusion, digital innovations are a continuously growing source of information and therapeutic tools., Competing Interests: Competing interests MF is a speaker for Boston Scientific. The remaining authors declare no conflict of interest., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: The objective of this manuscript is to assess the effect of varicocele repair (VR) in patients with clinical varicoceles on serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B serum levels., Materials and Methods: The study was performed in compliance with the Meta-Analysis and Systematic Reviews of Observational Studies (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). All eligible studies were selected following the PICOS (Population, Intervention, Comparison/Comparator, Outcomes, Study design) model. The values of each outcome measured after VR were compared to the before parameters and, when available, to the values on patients with unrepaired varicocele, and to those of healthy controls with no varicocele. For total testosterone, the values were sub-analyzed based on the mean total testosterone levels before VR (<300 ng/dL or >300 ng/dL), the fertility status, the time of follow-up and the technique used for VR., Results: From a total of 460 abstracts retrieved, 48 articles were included in our meta-analysis. Serum total testosterone levels were significantly higher after VR compared to both pre-treatment levels (mean difference [MD] 82.45 ng/dL, 95% confidence interval [CI]: 64.14-100.76; p<0.00001) and to the levels of patients with unrepaired varicocele (MD 91.64 ng/dL, 95% CI: 62.30-120.99; p<0.00001). They did not differ from the levels of healthy controls with no varicocele (MD -22.01 ng/dL, 95% CI: -68.59-24.58; p=0.35). The increase resulted to be independent from the mean total testosterone levels before VR, fertility status, time of follow-up and type of VR. After VR, a trend toward lower serum LH levels was found compared to before values (MD -0.37 IU/L, 95% CI: -0.74-0.01; p=0.06). When compared to the levels of patients with unrepaired VR, LH levels after VR were significantly lower (MD -0.96 IU/L, 95% CI: -1.56 to -0.35; p=0.002). LH levels were not significantly higher than healthy men without varicocele (MD 0.84 IU/L, 95% CI: -0.68-2.36; p=0.28). Patients with VR had significantly lower FSH levels compared to their pre-treatment values (MD -1.43 IU/L, 95% CI: -1.82 to -1.04; p<0.00001), and also to those of patients with non-repaired varicocele (MD -2.35 IU/L, 95% CI: -4.06 to -0.65; p=0.007). When compared to healthy controls with no varicocele, FSH levels were significantly higher (MD 2.71 IU/L, 95% CI: 1.12-4.31; p=0.0009). Lastly, after VR no significant change in inhibin B serum levels was seen compared to pre-treatment levels (MD 11.76 pg/mL, 95% CI: -3.83-27.35; p=0.14)., Conclusions: The present meta-analysis is the largest to date to assess the impact of VR on Leydig cell and Sertoli cell function using a before-after analysis for uncontrolled studies, and using data from patients with unrepaired varicoceles or healthy patients without varicocele as controls. VR was found to increase and restore to normality serum levels of total testosterone and LH. This evidence could be of value in considering the treatment of varicocele in patients with low testosterone or those who show a progressive decline in testosterone levels., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Background and Objective: Symptomatic benefit and urodynamic obstruction relief represent relevant outcomes of therapies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We summarized evidence from studies concurrently assessing variations in terms of symptoms severity and invasive urodynamic measures of obstruction following medical and surgical therapies for LUTS/BPH., Methods: We performed a systematic review of PubMed, Scopus, and Web of Science in June 2023., Key Findings and Limitations: We identified 29 publications: 14 (872 patients) and 15 (851 patients) studies addressing medical and surgical therapies, respectively. The mean percentage total International Prostate Symptom Score (IPSS) improvements ranged from -2.5% to 56.3% and from 35.1% to 82.1% following medical and surgical therapies, respectively. The corresponding mean percentage Bladder Outlet Obstruction Index (BOOI) improvements ranged from 7.8% to 53.5% and from 22.4% to 138.6%, respectively. Holmium laser enucleation of the prostate (HoLEP) provided IPSS improvements in the higher range and the greatest BOOI reduction., Conclusions and Clinical Implications: Globally, based on available evidence, more pronounced symptomatic benefits are observed following treatments providing greater deobstructive effect. In detail, patients undergoing surgery exhibit greater IPSS and BOOI improvements than those receiving medical therapy., (Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations., Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations., Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate., Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

The aim of this study is to investigate the role of [ 18 F]-PSMA-1007 PET in differentiating high- and low-risk prostate cancer (PCa) through a robust radiomics ensemble model. This retrospective study included 143 PCa patients who underwent [ 18 F]-PSMA-1007 PET/CT imaging. PCa areas were manually contoured on PET images and 1781 image biomarker standardization initiative (IBSI)-compliant radiomics features were extracted. A 30 times iterated preliminary analysis pipeline, comprising of the least absolute shrinkage and selection operator (LASSO) for feature selection and fivefold cross-validation for model optimization, was adopted to identify the most robust features to dataset variations, select candidate models for ensemble modelling, and optimize hyperparameters. Thirteen subsets of selected features, 11 generated from the preliminary analysis plus two additional subsets, the first based on the combination of robust and fine-tuning features, and the second only on fine-tuning features were used to train the model ensemble. Accuracy, area under curve (AUC), sensitivity, specificity, precision, and f-score values were calculated to provide models' performance. Friedman test, followed by post hoc tests corrected with Dunn-Sidak correction for multiple comparisons, was used to verify if statistically significant differences were found in the different ensemble models over the 30 iterations. The model ensemble trained with the combination of robust and fine-tuning features obtained the highest average accuracy (79.52%), AUC (85.75%), specificity (84.29%), precision (82.85%), and f-score (78.26%). Statistically significant differences (p < 0.05) were found for some performance metrics. These findings support the role of [ 18 F]-PSMA-1007 PET radiomics in improving risk stratification for PCa, by reducing dependence on biopsies., (© 2024. The Author(s).)

RNAs, especially non-coding RNAs (ncRNAs), are crucial players in regulating cellular mechanisms due to their ability to interact with and regulate other molecules. Altered expression patterns of ncRNAs have been observed in prostate cancer (PCa), contributing to the disease's initiation, progression, and treatment response. This study aimed to evaluate the ability of a specific set of RNAs, including long ncRNAs (lncRNAs), microRNAs (miRNAs), and mRNAs, to discriminate between PCa and the non-neoplastic condition benign prostatic hyperplasia (BPH). After selecting by literature mining the most relevant RNAs differentially expressed in biofluids from PCa patients, we evaluated their discriminatory power in samples of unfiltered urine from 50 PCa and 50 BPH patients using both real-time PCR and droplet digital PCR (ddPCR). Additionally, we also optimized a protocol for urine sample manipulation and RNA extraction. This two-way validation study allowed us to establish that miRNAs (i.e., miR-27b-3p, miR-574-3p, miR-30a-5p, and miR-125b-5p) are more efficient biomarkers for PCa compared to long RNAs (mRNAs and lncRNAs) (e.g., PCA3, PCAT18, and KLK3), as their dysregulation was consistently reported in the whole urine of patients with PCa compared to those with BPH in a statistically significant manner regardless of the quantification methodology performed. Moreover, a significant increase in diagnostic performance was observed when molecular signatures composed of different miRNAs were considered. Hence, the abovementioned circulating ncRNAs represent excellent potential non-invasive biomarkers in urine capable of effectively distinguishing individuals with PCa from those with BPH, potentially reducing cancer overdiagnosis.

Background: Surgical treatment of symptomatic benign prostatic hyperplasia (BPH) has seen an evolution during the last decades. On one hand, en-bloc HoLEP emerged as a valid endoscopic treatment regardless prostate size. On the other hand, robot-assisted simple prostatectomy (RASP) has gained attention in larger prostates showing encouraging results. Herein, for the first time in the scientific scenario, we sought to compare the outcomes of RASP and en-bloc HoLEP cases after propensity-score matching (PSM) analysis., Methods: We retrospectively queried our prospectively database of patients treated with HoLEP or RASP between 2017 and 2022 among two high-volume centers. PSM was applied based on the International Prostate Symptom Score (IPSS) questionnaire, prostate volume and max-flow rate. All procedures were performed by a single surgeon per center. Outcomes were assessed at 1, 3, and 6-month postoperatively and therefore annually. Trifecta definition was used to assess "success" in surgical procedures and was defined as the contemporary presence of: a) no postoperative complications within the first postoperative month; b) 1-month postoperative Qmax >15 ml/s and c) no urinary incontinence at 3-month evaluation., Results: Overall, 48 HoLEP and 47 RASPs were matched. Operative time, hospitalization time (median 4 vs 5 days) and catheterization time (median 3 vs 2 day) were found to be shorter in the HoLEP group as compared to the counterpart (p < 0.05). Early postoperative complication rate was also lower in the HoLEP cohort (6.2% vs 12.6%; p = 0.03) as well as postoperative haemoglobine blood level drop (1.4 vs 2.4 g/dL; p = 0.03). On the other hand, postoperative antegrade ejaculation (55.3% vs 6.8%) 1-month max flow (median 28 vs 24 ml/sec) and continence rates (0% vs 20.8%) favored RASP (p < 0.05). Overall, Trifecta rate was similar in the two groups (76.1% vs 82.6%)., Conclusion: Both HoLEP and RASP are safe and effective treatments for symptomatic BPH. HoLEP demonstrated to have lower perioperative risks while is affecting by a higher probability of transient early UI. On the other hand, RASP is more effective in reducing postoperative ejaculatory dysfunction., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Introduction: Placebo influence on such objective indicators, as sperm quality and infertility, has not been studied previously, but some studies report that placebo may distort even objective outcomes. The aim of current study is to assess the placebo effect on fertility in patients suffering from sperm abnormalities and/or infertility., Evidence Acquisition: We conducted a search of two databases (Scopus and MEDLINE) and identified placebo-controlled clinical trials which focused on sperm abnormalities and/or male infertility treatment. Primary outcomes included changes in semen parameters (volume, total count, sperm concentration in semen, progressive motility, morphology (normal cells)). Secondary outcomes included DNA fragmentation and change in pregnancy rate., Evidence Synthesis: Seventy-seven articles published from 1983 to 2022 were included. Statistically significant changes were observed for the following values: total sperm count, mean change 0.16 (95% CI 0.05, 0.26); P=0.004, I 2 =75.1%; and progressive motility, mean change 0.13 (95% CI 0.02, 0.24); P=0.026, I 2 =84.9%. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology or DNA fragmentation index. The publication bias for all the values measured with Egger's test and funnel plots was low., Conclusions: The current meta-analysis indicated a statistically significant increase of total sperm count and progressive motility in the placebo group. In contrast, placebo did not affect sperm concentration, sperm volume, sperm morphology and DNA fragmentation index. These findings should be considered while planning or analyzing placebo-controlled clinical trials.

Solid organ transplant recipients exhibit an elevated incidence of erectile dysfunction, attributed to comorbidities and specific factors associated with organ failure. While treatment mirrors the general population's, response rates are lower, and there is a heightened concern about implanting a penile prosthesis in immunocompromised patients due to the potential occurrence of severe complications. The aim of this study was to assess the safety of penile prostheses in this population. Among fourteen included studies, ten were case reports or series of cases, and four were non randomized case-control studies with non-transplanted patients as controls. Complications affected 34 patients (11.15%), with mechanical device failures in 18 cases (5.9%) and infections in 13 cases (4.26%). Most infections required hospitalization, antibiotic treatment, and prosthesis removal, with two cases of life-threatening Fournier's gangrene. Case-control studies revealed no differences in overall reoperation rates between transplant recipients and controls. However, pelvic organ transplant recipients undergoing three-piece prosthesis implantation showed higher complications rates related to reservoir issues. Despite limited evidence, case-control studies demonstrated a generally low/moderate risk of bias within each specific domain, although overall bias was moderate/severe. As a result, clinicians may mitigate concerns regarding penile prosthesis implantation in solid organ transplant recipients., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

Purpose: This study aimed to examine current global practices in regenerative therapy (RT) for erectile dysfunction (ED) and to establish expert recommendations for its use, addressing the current lack of solid evidence and standardized guidelines., Materials and Methods: A 39-question survey was developed by senior Global Andrology Forum (GAF) experts to comprehensively cover clinical aspects of RT. This was distributed globally via a secure online Google Form to ED specialists through the GAF website, international professional societies, and social media, the responses were analyzed and presented for frequencies as percentages. Consensus on expert recommendations for RT use was achieved using the Delphi method., Results: Out of 479 respondents from 62 countries, a third reported using RT for ED. The most popular treatment was low-intensity shock wave therapy (54.6%), followed by platelet-rich plasma (24.5%) and their combination (14.7%), with stem cell therapy being the least used (3.7%). The primary indication for RT was the refractory or adverse effects of PDE5 inhibitors, with the best effectiveness reported in middle-aged and mild-to-moderate ED patients. Respondents were confident about its overall safety, with a significant number expressing interest in RT's future use, despite pending guidelines support., Conclusions: This inaugural global survey reveals a growing use of RT in ED treatment, showcasing its diverse clinical applications and potential for future widespread adoption. However, the lack of comprehensive evidence and clear guidelines requires further research to standardize RT practices in ED treatment., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Purpose: Augmented adiposity may negatively impact sexual sphere through its metabolic effects and its detrimental impact on reproductive hormones. Moreover, a dysregulated metabolic pathway may promote apoptosis among spermatogenic cells. Based on these premises, a relation between weights loss and ameliorate semen parameters seems beneficial. To investigate if physical activity may affect semen parameters and fertility rate, a systematic literature search on major dataset has been performed., Materials and Methods: The search terms included: "Assisted reproduction therapies," "fertility," "semen parameters," "sperm parameters," and "physical activity." This analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and it was registered on PROSPERO (CRD42023384471). A total of 47 studies have been identified; 1 reference has been eliminated after duplication check. After preliminary screening 32 papers have been excluded. Considering the exclusion criteria, 15 full-text articles were evaluated for eligibility. After a full-text review, six studies published during a span of eight years (2014-2022) have been included in the meta-analysis. Semen parameters, pregnancy and birth rates were investigated. The revised Cochrane risk of bias tool (Rob2) has been used to check the risk of bias., Results: The number of patients enrolled in studies ranges from 17 to 521; in the end, a total of 1,637 patients have been enrolled in the study. Fertility parameters investigated were semen quality parameters and pregnancy rates and live births. A statistically significant relationship between physical exercise and sperm concentration (p=0.02), total sperm motility (p<0.01), total sperm count (p<0.01), normal morphology (p<0.01) has been established. Moreover, the study registered a statistically significant association within physical activity and total pregnancy rate (p<0.01) and live birth rate (p<0.01)., Conclusions: We demonstrated that physical activity is significantly associated with amelioration of semen parameters and may be crucial in improving or even reverting male infertility., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)

Purpose: Varicocele has been associated with high seminal oxidative stress (OS), impaired semen quality, and reduced male fertility potential. However, the exact mechanism(s) underlying the development of varicocele-mediated infertility and the cause-effect relationship between varicocele and testicular dysfunction are not fully understood. The aim of this systematic review and meta-analysis (SRMA) is to investigate the impact of varicocele on testicular OS markers and sperm parameters in experimental animals with varicocele as compared to animals without varicocele., Materials and Methods: A literature search was performed using the Scopus and PubMed databases on studies that investigated testicular OS markers and sperm parameters in animals with varicocele. The primary outcomes included malondialdehyde (MDA) (nmol/mg) levels whereas the secondary outcomes included total sperm count (×10 6 ), sperm vitality (%), total sperm motility (%), and sperm DNA fragmentation (SDF) (%). Standardized mean difference (SMD) (95% confidence interval [CI]) was chosen to express the effect size. The quality of the included studies was evaluated using the Cambridge Quality Checklist., Results: Out of 76 identified articles, 6 studies on rats were included in the meta-analysis. The analysis showed a significant increase of MDA (SMD: 15.61 [1.93, 29.29]; p=0.03) in rats with varicocele vs. controls. We also observed a significant decrease in total sperm count (SMD: -17.45 [-28.97, -5.93]; p<0.01), sperm vitality (SMD: -16.41 [-26.30, -6.52]; p<0.01), total sperm motility (SMD: -17.67 [-24.90, -10.44]; p<0.01), and a significant increase of SDF (SMD: 7.41 [1.23, 13.59]; p=0.02), in rats with varicocele vs. controls. The quality of the included studies was ranked as high., Conclusions: This SRMA indicates a significant increase in levels of testicular MDA and SDF and a reduction of sperm quality in experimental animals with varicocele. These findings support the potential role of testicular OS in the development of varicocele-induced testicular damage., Competing Interests: The authors have nothing to disclose., (Copyright © 2024 Korean Society for Sexual Medicine and Andrology.)