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Context: Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective: To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition: A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis: The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions: Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary: We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message: Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient’s quality of life.

Sustainable land management is one of the key actions for the achievement of objectives set by the 2030 Agenda for Sustainable Development. In particular, land represents a fundamental resource to address issues of climate change, biodiversity preservation, maintaining ecosystem services, and at the same time ensuring shared prosperity and well-being. Therefore, it is necessary to activate strategies to monitor changes in land use and land cover in order to evaluate strategies for proper management. To do this, the new open source geospatial analysis tools and the increasing availability of remote sensed open data can allow the activation of methodologies for monitoring changes in land use and land cover in order to provide data usable in other research areas or, for example, to implement a decision support system for environmental sustainability. In this study, a GIS approach based on open remote sensing data has been used to perform a spatial analysis of land cover changes within the Basilicata region (Southern Italy) that is spatially expeditious yet accurate. The results showed a very evident land transformation with important repercussions on the environmental components. The ease of use of techniques makes this methodology replicable in other territory and can be used as a preliminary approach to sustainable development model.

Recently, 3D models (3DM) gained popularity in urology, especially in nephron-sparing interventions (NSI). Up to now, the application of artificial intelligence (AI) techniques alone does not allow us to obtain a 3DM adequate to plan a robot-assisted partial nephrectomy (RAPN). Integration of AI with computer vision algorithms seems promising as it allows to speed up the process. Herein, we present a 3DM realized with the integration of AI and a computer vision approach (CVA), displaying the utility of AI-based Hyper Accuracy Three-dimensional (HA3D®) models in preoperative planning and intraoperative decision-making process of challenging robotic NSI. A 54-year-old Caucasian female with no past medical history was referred to the urologist for incidental detection of the right renal mass. Preoperative contrast-enhanced abdominal CT confirmed a 35 × 25 mm lesion on the anterior surface of the upper pole (PADUA 7), with no signs of distant metastasis. CT images in DICOM format were processed to obtain a HA3D® model. RAPN was performed using Da Vinci Xi surgical system in a three-arm configuration. The enucleation strategy was achieved after selective clamping of the tumor-feeding artery. Overall operative time was 85 min (14 min of warm ischemia time). No intra-, peri- and post-operative complications were recorded. Histopathological examination revealed a ccRCC (stage pT1aNxMx). AI is breaking new ground in medical image analysis panorama, with enormous potential in organ/tissue classification and segmentation, thus obtaining 3DM automatically and repetitively. Realized with the integration of AI and CVA, the results of our 3DM were accurate as demonstrated during NSI, proving the potentialities of this approach for HA3D® models’ reconstruction.

The rural built heritage constitutes a unique example, due to architectural and technical issues, which plays a central role in the formation of rural landscape. In this research, interactions between rural buildings and the surrounding land have been examined. Two case studies exemplifying some of typical dynamics of some internal mountain areas of Mediterranean region have been considered. These areas are located in Basilicata Region (Southern Italy) and suffer from land and rural buildings heritage abandonment, as well as from the concurrent disappearance of agroforestry systems with high ecological value. A multi-chronological geo-database incorporating different land cover datasets over a period of 62 years (1955–1988–2008–2017) has been implemented into a GIS to assess relationships between some rural buildings and the surrounding land have been then assessed. This has been achieved by integrating different types of remote-sensed geodata: historical aerial photos, digital orthophotos and satellite images. The analyses carried out have shown that the intensity of land abandonment can also be related to the type of rural building and prevalent agricultural activity. Moreover, thanks to this methodology, it has been possible to produce several spatial information useful to support public decisionmakers at different level.

Objective: Nowadays the development of new technologies in urological field allows to perform surgical approaches tailored on the characteristics of each single case. Three-dimensional virtual models (3DVMs) have been developed in the last years to overcome the “building in mind” process that the surgeon should do to perceive the features of the organs in a real human body from CT scan images. Aim of the study is to report our experience regarding the use of 3DVMs in the planning and intraoperative navigation during minimally-invasive nephron sparing surgery (mi-NSS) in highly complex renal tumors. Patients and surgical procedure: We prospectively recorded preoperative, perioperative and functional data of high complex renal tumor who underwent miNSS from August 2017 to August 2021. All patients performed contrast-enhanced CT from which a 3DVM was obtained. Using such technological tools, it was possible to identify three different application field from the planning to the end of the surgery to optimize the success of the procedure. Results: Overall, 79 patients harboring PADUA> 10 unilateral renal masses were prospectively selected from our Institutional database. At CT scan the median clinical size was 50 mm, IQR: [43.5–60]. Concerning intraoperative characteristics, 34.1 and 24.1% of patients underwent selective or clampless NSS. The rate of positive surgical margin (PSM) was 2.5%. and the rate of postoperative complications was 16.5%. The difference between preoperative and postoperative eGFR was not meaningful (21% IQR: [1.8–32.7]). The MIC score was achieved in 87.3% of patients. The major complications rate (Clavien-Dindo> 2) was 2.5%. Conclusions: 3D models represent a useful tool to plan a tailored surgical approach in cases of surgically complex masses. They can be used in different ways, matching the surgeon's needs from the planning phase to the demolitive and reconstructive phase.

Objectives: To present our Urethral Sparing Robotic-Assisted Simple Prostatectomy (usRASP) technique for large Benign Prostatic Enlargement (BPE) and to evaluate its efficacy in maintaining antegrade ejaculation. Patients and surgical procedures: In this prospective study we enrolled consecutive patients who underwent RASP with urethral-sparing intent for large (>80cc) prostate at our Institution.Demographic variables were recorded. Functional data including uroflowmetry, PVR evaluation, IPSS score and MSHQ-EjD were assessed before the intervention and after 1, 3, 6 and 12 months post-operatively. Perioperative data were equally collected. Surgical technique: the procedure starts as a standard RASP, left and right lobes are enucleated separately leaving the urethra untouched. Prostatic capsule is then sutured by using a 3/0 barbed suture.On the basis of the final intraoperative result, patients were divided into three subgroups (full, partial or failed urethral sparing). Perioperative and functional results of these three subgroups were then compared. Results: 124 patients were enrolled, mean age was 67 y (± 6.5), mean prostate size was 140 cc (+_32cc), mean operative time was 110′ (97–122). No Clavien-Dindo >2 grade complications were recorded. Full and partial urethral-sparing RASP was performed in 81 and 25 cases respectively whilst in 18 cases (15%) the procedure was converted to standard RASP. Qmax increased of 16 ml/sec (+200%) and IPSS score decreased (from 20 to 5 points, -75%) from baseline (p

Background: Surgical mortality risk scores, even if not properly designed and rarely tested in the transcatheter aortic valve implantation (TAVI) setting, still guide the heart team in managing significant aortic stenosis. Methods: After splitting 1763 consecutive patients retrospectively based on their mortality risk thresholds, the composite endpoint early safety (ES) was adjudicated according to Valve Academic Research Consortium (VARC)-2 and -3 consensus documents. Results: ES incidence was higher if VARC-2 rather than VARC-3 defined. Despite only patients showing VARC-2 ES had significantly lower absolute values of all three main risk scores, these last still failed to foresee both VARC-2 and -3 ES in intermediate-risk patients. The receiver operating characteristic analysis also showed a significant correlation, but with poor diagnostic accuracy, among the three scores and only VARC-2 ES; moreover, the absence of VARC-2 ES and low-osmolar contrast media administration were identified as independent predictors of 1-year mortality and absence of VARC-3 ES, respectively. Finally, even a single complication included in the ES definition could significantly affect 1-year mortality. Conclusion: Currently, the most used mortality risk scores do not have adequate diagnostic accuracy in predicting ES after TAVI. The absence of VARC-2, instead of VARC-3, ES is an independent predictor of 1-year mortality.

The faba bean (Vicia faba L. var. major) is a pulse that is garnering attention for its chemical composition, which makes it suitable for a healthy diet. The Apulian germplasm is rich in local accessions at risk of genetic erosion, which need evaluating and promoting. Thirteen Vicia faba local Landraces have been analyzed in relation to their productivity and their chemical and biochemical characteristics: their protein, total phenol, total flavonoid, condensate tannin and L-DOPA levels. The results showed great variability—above all in the thousand-seeds weight and in their content of proteins and L-DOPA. Among the accessions evaluated, the two collected from the most southern area of the region (FV12-FV10) were particularly promising—both for their good biochemical traits and, especially, for the higher L-DOPA content (0.46 and 0.49 g 100 g−1 d.m., respectively), even when expressed in terms of yield per plant (116.3 and 153.0 mg plant−1 d.m., respectively).

Land abandonment is among the most complex la nd use change processes driven by a multiplicity of anthropogenic and natural factors, such as agricultural over-exploitation, implementation of agricultural policies, socio-economic and climatic aspects. Therefore, it is necessary to deepen the effects of land abandonment based on methodologies that are as multidisciplinary as possible. Environmental and social problems related to abandonment include soil erosion and environmental degradation. Approaches combining GIS (Geographic Information System), remote sensing, and image analysis techniques allow for assessments and predictions based on integrating theoretical models with advanced geospatial and geostatistical models. One of the most widely used models for soil erosion estimation is the Revised Universal Soil Loss Equation (RUSLE). The present work developed a model using remote sensing and GIS tools to investigate some factors of the RUSLE equation to evaluate the adverse effects of soil erosion in areas covered by arable crops and subsequently abandoned. To identify potentially degraded areas, two factors of the RUSLE were related: the C Factor describing the vegetation cover of the soil and the A Factor representing the amount of potential soil erosion. Through statistical correlation analysis with the RUSLE factors, based on the deviations from the average erosion values and mapping of the areas of vegetation degradation relating to arable land, the areas identified and mapped are susceptible to soil degradation.

Backgound and objectives: In recent years, the adoption of 3D models for surgical planning and intraoperative guidance has gained a wide diffusion. The aim of this study was to evaluate the surgeons’ perception and usability of ICON3DTM platform for robotic and laparoscopic urological surgical procedures. Materials and Methods: During the 10th edition of the Techno-Urology Meeting, surgeons and attendees had the opportunity to test the new ICON3DTM platform. The capability of the user to manipulate the model with hands/mouse, the software usability, the quality of the 3D model’s reproduction, and the quality of its use during the surgery were evaluated with the Health Information Technology Usability Evaluation Scale (Health-ITUES) and the User-Experience Questionnaire (UEQ). Results: Fifty-three participants responded to the questionnaires. Based on the answers to the Health-ITUES questionnaire, ICON3DTM resulted to have a positive additional value in presurgical/surgical planning with 43.4% and 39.6% of responders that rated 4 (agree) and 5 (strongly agree), respectively. Regarding the UEQ questionnaire, both mouse and infrared hand-tracking system resulted to be easy to use for 99% of the responders, while the software resulted to be easy to use for 93.4% of the responders. Conclusions: In conclusion, ICON3DTM has been widely appreciated by urologists thanks to its various applications, from preoperative planning to its support for intraoperative decision-making in both robot-assisted and laparoscopic settings.

This study collects the results obtained using the Getis-Ord local spatial autocorrelation index (Gi) with the aim of improving the classification of burned area detection maps generated from spectral indices (i.e., dNBR index) derived from Sentinel-2 satellite data. Therefore, the work proposes an adaptive thresholding approach that also includes the application of a similarity index (Sorensen–Dice Similarity Index) with the aim of adaptively correcting classification errors (false-positive burned pixels) related to the spectral response of burned/unburned areas. In this way, two new indices derived from the application of the Getis-Ord local autocorrelation analysis were created to test their effectiveness. Three wildfire events were considered, two of which occurred in Southern Italy in the summer of 2017 and one in Sardinia in the summer of 2019. The accuracy assessment analysis was carried out using the CEMS (Copernicus Emergency Management Service) on-demand maps. The results show the remarkable performance of the two new indices in terms of their ability to reduce the false positives generated by dNBR. In the three sites considered, the false-positive reduction percentage was around 95–96%. The proposed approach seems to be adaptable to different vegetation contexts, and above all, it could be a useful tool for mapping burned areas to support post-fire management activities. [ABSTRACT FROM AUTHOR]

Background: Lower urinary tract symptoms (LUTS) contribute to erectile dysfunction (ED) and premature ejaculation (PE). However, only a few studies have been conducted with representative groups of men that had well-balanced demographic characteristics. Thus, we aimed to confirm the effect of LUTS on ED and PE and to analyze the association between LUTS and men's sexual activity in a large representative cohort. In addition, we evaluated the sex-specific and overall quality of life of men who had LUTS with either ED or PE. Methods: We used the latest census and estimated the sample size to build a group of men representative of the population. LUTS, ED, and PE were evaluated with reliable instruments. Regression models were used to analyze the data. Results: All included men were representative in relation to their age and residential location (n = 3001). ED and PE were more common in men who reported LUTS compared with men who did not have LUTS (p < 0.001). Age, comorbidity, and lifestyle did not affect the negative effect of LUTS on ED or PE (regression coefficients of 0.159 and 0.528 for ED and PE, respectively, p < 0.001). However, regression models did not validate the impact of LUTS on sexual activity, defined by intercourse frequency and number of sexual partners (odds ratio of 0.981, CI 0.961–1.001, p = 0.061). Nevertheless, men with LUTS and either ED or PE had worse quality of sexual life and general quality of life compared with the remaining respondents. Conclusion: LUTS worsened ED and PE but had no impact on men's sexual activity. Our findings confirm the recommendations to assess for LUTS in men reporting ED or PE. Clinical Trial Registration: The study was registered with ClinicalTrials.gov (NCT05462171). [ABSTRACT FROM AUTHOR]

Objective: In 3% of cases renal cell carcinoma (RCC) is diagnosed with synchronous bilateral renal masses. However, until today, the optimal treatment strategies for these patients remain unknown.In clinical practice bilateral partial nephrectomies (PNs) are the treatment of choice because of the functional advantage relative to radical nephrectomy. Aim of the study is to show how the availability of such three-dimensional virtual model (3DVM) can be helpful in planning the surgical strategy in a challenging clinical case of bilateral highly complex renal masses.Patients and surgical procedure: one patient with high complexity bilateral renal masses (PADUA 13) was selected from our Institutional database. The patient underwent contrast-enhanced CT from which a 3DVM was obtained. Using such technological tool, it was possible to set the surgical strategy considering the anatomical details of the organ, leading the surgeon to plan synchronous right robot-assisted radical nephrectomy (RARN) and the sacrifice of the upper portion of the left kidney in light of its irrelevant contribution to the postoperative global renal function even if spared. Results: Operative time were 80 min and 148 min, for robot assisted partial nephrectomy and RARN, respectively. Total estimated blood loss was 350 ml with an ischemia time of 23.4 min. No intraoperative or postoperative complications have been recorded. At final pathological examination both kidneys presented a pT3a clear cell RCC. No positive surgical margins were recorded. DJ stent was removed 45 days after surgery. The patient was treated with dialysis for 6 months after surgery. One year later, serum creatinine level was 2.2 mg/dl, with an eGFR of 33%. No further dialytic sessions were needed. Conclusions: The use of 3DVMs, even if in case of extreme surgeries such as a synchronous radical and partial nephrectomy, allows to plan the most effective surgical strategy, well balancing the risk of complications with the postoperative recovery of the renal remnant.

Objective: In the last years three dimensional virtual models (3DVMs) had a widespread diffusion in the renal surgery field thanks to their more precise representation of anatomical details. Among the different ways to use the 3DVMs, Augmented reality seems one of the most promising thanks to the possibility of its application during both preoperative planning and intraoperative surgical navigation. In this study we show how to create hyper-accuracy 3DVMs and our specifically developed platform to perform Augmented reality Robot-assisted partial nephrectomy Patients and surgical procedure: From our prospectively maintained database we extracted all patients with localized renal mass underwent Augmented reality (AR) RAPN. Preoperatively all patients underwent a multiphase contrast enhanced CT-scan. From that DICOM images hyper-accuracy 3DVMs were built. Then to perform AR, the 3DVMs are overlayed on the endoscopic video of the Da-Vinci remote surgical console, thanks to a dedicated software, named Rviewer. Results: 65 patients were finally included in this analysis. The median tumor size was 50 mm with a PADUA score of 9. Concerning intraoperative variables, a higher rate of selective clamping and enucleation technique were recorded. The positive surgical margin (PSM) rate and the major complications rate (Clavien-Dindo>2) were 2.5 and 2.1%, respectively. The difference between preoperative and postoperative eGFR was not meaningful. The MIC score was gained in 87.3% of patients. Conclusions: In conclusion AR is still constantly evolving but it has already showed to represent a safe and effective application of 3DVMs. Moreover, in this era in which we are pushing through the limits of NSS and surgeons have to manage more large and complex renal mass than before, AR could represent a valid tool to maximize the probability of success and the perioperative outcome of partial nephrectomy.