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INTRODUCTION: Vasectomy is a widely used, safe, effective method of permanent contraception and contributes to healthy sexuality. AIMS: We have conducted a 3-step observational clinical study to develop a vasectomy regret risk score and guide patients and clinicians when discussing a vasectomy. METHODS: A 3-step approach has been followed. First, experts involved in male health have proposed risk factors for regret (remorse) after vasectomy, defined by a vasectomy reversal surgery or medically assisted reproduction. The selected factors were evaluated in 1200 patients vasectomized in the last 15 years. Finally, the expert panel has constructed a score for predicting regret after vasectomy. RESULTS: Fifty-two international experts identified 17 risk factors for vasectomy regret. Five of the risk factors were significant: an age

PurposeEjaculatory abstinence (EA) duration is recognized to impact semen parameters. This study aims to evaluate the effects of varying EA durations on semen quality parameters, distinguishing between normospermic and sub-fertile men, and to provide insights into tailored abstinence recommendations for improved fertility outcomes.MethodsWe retrospectively analyzed 23,527 semen samples from men undergoing infertility evaluation from 2013 to 2024. Semen parameters, including sperm concentration, motility, and morphology, were assessed post-abstinence (2–7 days) according to WHO guidelines. Group differences were analyzed, focusing on sperm parameters across abstinence periods in normospermic versus patients with sperm abnormalities.ResultsIn normospermic patients we found a trend increase from day 1 to day 7 of abstinence time regarding total sperm count (million) (92.4 vs. 191.1; p

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

The present study was conducted to investigate the effects of fish meal (FM) replacement with full fat Hermetia illucens (HI) on the molecular mechanisms regulating lipid and bile salt (BA) homeostasis in rainbow trout (Oncorhynchus mykiss) juveniles. We thus explore the presence of 20-hydroxyecdysone (20E) in an insect meal-based diet and evaluate its potential involvement in regulating the molecular mechanisms/basis of FXR:RXR axis signaling. Ecdysteroids are a category of steroid hormones which bind a nuclear–receptor complex composed of ecdysone receptor (EcR) and ultraspiracle protein (USP) and regulate insect molting and metamorphosis. In all vertebrates, including fish, EcR-USP homologs are the Farnesoid X receptors (FXR) and the Retinoid X receptors (RXR), which are known to regulate crucial physiological and metabolic aspects, including BA synthesis and cholesterol homeostasis. In silico prediction indicates that 20E binds the heterodimeric complex with a binding affinity constant Kd equals to 610 ± 60 nM and affects positively the dimerization process. Results also demonstrated the coordinated increased expression of FXR and RXR, as well as their downstream target genes (i.e. short heterodimer partner 1 and 2) in rainbow trout fed diets containing HI meal. This latter finding was paralleled by a significant down-regulation of CYP7a1 and CYP8b1 gene expression together with a decrease in hepatic total cholesterol, triglyceride, and BA levels. Overall, our study suggested that FXR is a potential target for 20E content in insect meal and provided preliminary data on the potential role of ecdysteroids in regulating the metabolic status of teleost fish through modulation of FXR signaling in the enterohepatic system.

Foamed polystyrene (PS) is a prevalent material in consumer products and thus represents one of the largest constituents of marine litter. PS may interact with and be ingested by various organisms, including insects, which are starting to be used in biodegradation of plastic wastes. This study examines the physiological performances and the potential oxidative stress related to dietary environmental PS exposure of Z. morio larvae. Experimental groups were fed different diets: bran and oatmeal (control), weathered PS collected from the marine environment, and virgin PS. Over a 30-day feeding period, larvae growth, survival, and PS consumption were measured, together with antioxidant enzymatic activities and gene expression profiles. Results showed that PS ingestion supports larval growth similarly to bran, but the two PS-fed groups consumed a different amount of plastic, suggesting that weathered PS might affect the patterns of PS consumption by larvae. We denoted that PS consumption was associated with a decline in total antioxidant capacity, which showed the highest decrease in the environmental PS group. Marked increases in oxidative stress biomarkers such as superoxide dismutase (SOD) activity/mRNA levels and malondialdehyde content were also observed in the environmental PS-fed group, indicating an elevated oxidative stress response, probably due to pollutants adsorbed/absorbed on PS. Differently to SOD, catalase at both mRNA and enzyme activity levels was found to be significantly reduced by PS digestion, regardless of PS type. The mRNA levels of glutathione s-transferase (GST) were significantly higher in the environmental PS-fed larvae compared to the virgin PS-fed group. In addition, Principal Component Analysis clearly distinguished between larvae fed different PS types, highlighting the enhanced oxidative stress caused by the ingestion of PS collected from marine environments. These results support the potential of insects in plastic biodegradation processes but also demonstrate the health hazards of using environmental PS as principal dietary component in Z. morio larvae, thus questioning their use in downstream productions.

Erectile dysfunction (ED) poses a significant challenge in clinical practice, necessitating accurate diagnostic strategies to distinguish between organic and psychogenic causes. Current guidelines advocate a comprehensive approach involving medical history, physical examination and blood tests, with second-level analyses like the intracavernous injection of vasoactive drugs (ICI test) and penile duplex ultrasound (PDU) reserved for specific cases. A survey involving 24 urologists experienced in ED was conducted to assess their opinions on the appropriateness of the ICI test and PDU in six clinical scenarios. Results were analyzed using pie charts, revealing varied preferences among experts. The responses indicated diverse viewpoints, with preferences for the ICI test or PDU depending on the patient’s age, comorbidities, response to phosphodiesterase type 5 inhibitors (PDE5i) and concomitant Peyronie’s disease. In some cases, a significant proportion of experts opted for neither test. The study highlights the lack of consensus among experts regarding the routine use of PDU in ED management. Despite its diagnostic capabilities, the clinical utility of PDU remains unclear, and its role may be more justified in certain populations with anatomical abnormalities or specific conditions. The need for rigorous research to determine the impact of PDU on ED management decision-making is emphasized.

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus method. Methods: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and finalized. Results: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading to statements and recommendations. Conclusion: Echolaser® TPLA is a safe and effective procedure that treats BPH and localized PCa with satisfactory functional and sexual outcomes.

Introduction: Gender dysphoria refers to the distress or discomfort experienced when a person's gender identity does not align with the sex assigned at birth. While many transgender individuals affirm their gender identity without surgical intervention, an increasing number undergo gender-confirming surgery. It is essential to recognize and promptly treat vascular complications that can arise during these procedures. There are no previous reports addressing arterial injuries during the implantation of penile prostheses for gender-confirming surgery. Case presentation: A 33-year-old patient with gender dysphoria underwent female-to-male surgical interventions for gender confirmation. During the latest urologic procedure, which involved the implantation of a three-piece inflatable penile prosthesis, a vascular complication occurred, resulting in injury to the right common femoral artery. Given the extent of the injury and the difficulty in repairing the arterial wall, vascular surgeons resected the damaged artery segment and performed an end-to-end anastomosis. Intraoperative duplex ultrasound at the conclusion of the surgery showed a triphasic waveform in the distal vessels. The urologist decided to postpone the implantation of the penile prosthesis. The patient was discharged on the sixth postoperative day without systemic or local complications and was prescribed single antiplatelet therapy. Conclusions: With the increasing number of transgender individuals seeking gender-affirming surgery, it is important to conduct a multidisciplinary preoperative evaluation to minimize complications that could affect their quality of life.

Chronic sleep restriction (CSR) is a prevalent issue in modern society that is associated with several pathological states, ranging from neuropsychiatric to metabolic diseases. Despite its known impact on metabolism, the specific effects of CSR on the molecular mechanisms involved in maintaining metabolic homeostasis at the level of white adipose tissue (WAT) remain poorly understood. Therefore, this study aimed to investigate the influence of CSR on sirtuin 1 (SIRT1) and the peroxisome proliferator-activated receptor γ (PPARγ) signaling pathway in the WAT of young male mice. Both genes interact with specific targets involved in multiple metabolic processes, including adipocyte differentiation, browning, and lipid metabolism. The quantitative PCR (qPCR) results demonstrated a significant upregulation of SIRT-1 and some of its target genes associated with the transcriptional regulation of lipid homeostasis (i.e., PPARα, PPARγ, PGC-1α, and SREBF) and adipose tissue development (i.e., leptin, adiponectin) in CSR mice. On the contrary, DNA-binding transcription factors (i.e., CEBP-β and C-myc), which play a pivotal function during the adipogenesis process, were found to be down-regulated. Our results also suggest that the induction of SIRT1-dependent molecular pathways prevents weight gain. Overall, these findings offer new, valuable insights into the molecular adaptations of WAT to CSR, in order to support increased energy demand due to sleep loss.

Objective: This study aims to evaluate long-term functional, sexual, and cosmetic outcomes in adult patients who underwent hypospadias repair during childhood at a national highly specialized pediatric hospital. Methods: Medical records of pediatric patients who had undergone surgical repair of hypospadias between 1993 and 2004 at Meyer Children Hospital of Florence were reviewed. Adult patients were contacted by telephone between July and August 2021 and invited to participate. Long-term surgical outcomes were assessed focusing on complications and reinterventions, and 3 validated questionnaires on urinary function, erectile function, and penile cosmetic appearance were administered. Results: From January 1993 to December 2004, a total of 799 patients with hypospadias underwent repair surgery. Two hundred thirty-nine patients gave consent to be included in the study. Follow-ups occurred between 17 and 28 years after the first surgery. Most patients had anterior localization of hypospadias (210/239) and associated penile curvature (132/239). The most frequent surgery for hypospadias repair was meatal advancement and glanduloplasty incorporated (MAGPI) (88/239), and the most used surgical treatment for penile curvature was the Nesbit technique (49/132). The complication rate was 27% (65/239) in an average time of 4.7 years, and 48 surgical procedures have been performed to treat them. At follow-up, the mean IPSS was 0.96 ± 1.97, the mean IIEF-5 score was 24.10 ± 1.02, and the mean HOSE score was 15.47 ± 0.45. Patients who underwent reintervention reported a lower IPSS than those who underwent only 1 surgery (0.29 vs. 1.16). Conclusion: Hypospadias repair during childhood leads to rather normal urinary and sexual function and penile cosmetic appearance in adolescence and adulthood.

The grey squirrel, an invasive species, threatens the Eurasian red squirrel’s conservation, particularly in Umbria, Italy. Understanding its reproductive biology is essential to limiting its reproductive success. This study investigates the NGF system and its receptors (NTRK1 and p75NTR) in the testes of male grey squirrels, following prior research on female reproductive biology. NGF plays a role in testicular morphogenesis and spermiogenesis in animals and humans. As part of the LIFE Project U-SAVEREDS, eighteen squirrels were captured and classified into three morphotypes (immature, pubertal, and active spermatogenesis). NGF and its receptors were analyzed using real-time PCR, western blotting, immunohistochemistry, and plasma levels measured via ELISA. NGF qPCR expression levels were significantly higher during puberty compared to the immature and spermatogenesis stages (p < 0.01). Immunohistochemistry revealed NGF in Leydig cells, with stronger staining in pubertal and mature squirrels, while NTRK1 was found in Leydig cells in immature squirrels and germ cells in pubertal and mature ones. NGF receptors were observed in Sertoli cells in pubertal and mature squirrels. Plasma NGF levels showed a significant upregulation in pubertal squirrels (135.80 ± 12 pg/mL) compared to those in the immature (25.60 ± 9.32 pg/mL) and spermatogenesis stages (34.20 ± 6.06 pg/mL), with a p value < 0.01. The co-localization of NGF and its receptors suggests that NGF, produced by Leydig cells, regulates testis development and reproductive success through autocrine or paracrine mechanisms, potentially involving an unidentified pathway.

Objective: The management of chronic prostatitis/chronic pelvic pain syndrome type III (CP/CPPS) has been always considered complex due to several biopsychological factors underlying the disease. In this clinical study, we aimed to evaluate the efficacy of the treatment with Palmitoylethanolamide, Epilobium and Calendula extract in patients with CP/CPPS III. Materials and methods: From June 2023 to July 2023, we enrolled 45 consecutive patients affected by CP/CPPS type III in three different institution. We included patients aged between 18 and 75 years with symptoms of pelvic pain for 3 months or more before the study, a total National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score ≥ 12 point and diagnosed with NIH category III, according to 4-glass test Meares-Stamey test. Patients were then allocated to receive rectal suppositories of PEA, Epilobium and Calendula, 1 suppository/ die for 1 month. All patients have been tested with standard urinalysis in order to assess urinary leukocytes (U-WBC). The primary endpoint of the study was the reduction of NIHCPSI. The secondary outcomes were the change of peak flow, post-void residual (PVR), IIEF-5, VAS score, PSA and decrease of U-WBC. Results: A total of 45 patients concluded the study protocol. At baseline, the median age of all the patients included in the cohort was 49 years, the median PSA was 2.81 ng/mL, the median NIH-CPSI was 18.55, the median IIEF-5 was 18.27, the median U-WBC was 485.3/mmc, the median VAS score was 6.49, the median PVR was 26.5 mL and the median peak flow was 16.3 mL/s. After 1 month of therapy we observed a statistically significant improvement of NIH-CPSI, U-WBC, PSA, IIEF-5, peak flow, PVR and VAS. Conclusions: In this observational study, we showed the clinical efficacy of the treatment with PEA, Epilobium and Calendula, 1 suppository/die for 1 month, in patients with CP/CPPS III. The benefits of this treatment could be related to the reduction of inflammatory cells in the urine that could imply a reduction of inflammatory cytokines. These results should be confirmed in further studies with greater sample size.

PurposeThis study aimed to investigate the effects of ejaculatory abstinence on sperm parameters.MethodsThis analysis was registered in PROSPERO (CRD42023472124). We performed a search on PubMed using the following text terms: ((“sperm parameters” OR “sperm analysis” [Mesh]) AND (“sperm DNA fragmentation” OR “DNA fragmentation” [Mesh]) AND (“sexual abstinence” [Mesh] OR “abstinence”)) and an advanced search in Scopus using the terms (“sperm parameters” OR “sperm parameters” OR “DNA fragmentation”) AND (“abstinence”). The sperm parameters that were investigated were sperm volume, total sperm motility, progressive sperm motility, sperm concentration, sperm morphology, and sperm DNA fragmentation (SDF). A two-day cut-off as a “short” or “long” abstinence period has been defined.ResultsThirteen studies published between 2013 and 2022 were included in this meta-analysis. A total of 2,315 patients, ranging from 6 to 836 from each cohort, were enrolled in the study. We showed that longer abstinence time was associated with greater sperm concentration (mean difference [MD]: 8.19; p

Purpose: The present study sought to provide reproducible and patient-oriented metrics to assess the rate of “successful” outcomes (Trifecta) following holmium laser enucleation of the prostate (HoLEP). Clinical and surgical predictors of failure to achieve Trifecta were investigated. Materials and Methods: We queried our prospectively collected database of all patients treated with HoLEP between March 2017 and January 2021. Trifecta was defined as the contemporary presence of: (1) no postoperative complication within 3 months; (2) no urinary incontinence at 3-months follow-up; and (3) 3-month postoperative max flow-rate >15 mL/s. Cases were grouped according to Trifecta achievement. All surgical procedures were carried out by a single surgeon. Surgical experience was divided into two different eras according to the number of procedures conducted (surgical era). Multivariate logistic regression analysis was performed to assess predictors of Trifecta failure. Results: Overall 305 patients were included. Of these, 192 patients (63.0%) achieved Trifecta. Preoperative patient-related features were comparable between the two groups, except for a higher post-void residual (PVR) in non-Trifecta patients (median 180 vs. 130 mL, p=0.003). A significant proportion of Trifecta patients (88.5%) were treated in the second surgical era and in 126 (65.6%) cases an en-bloc enucleation was performed. Multivariate analysis confirmed PVR ≥250 mL, first surgical era and standard three-lobes enucleation technique as independent predictors of Trifecta failure. Conclusions: In our experience the rate of “successful” HoLEP, defined according to our newly introduced Trifecta metric, was 63.0%. We demonstrated that surgical strategy together with rising experience and baseline PVR are key elements to forecast the outcomes.

Prostate-specific antigen (PSA) testing as the sole indication for prostate biopsy lacks specificity, resulting in overdiagnosis of indolent prostate cancer (PCa) and missing clinically significant PCa (csPCa). SelectMDx is a biomarker-based risk score to assess urinary HOXC6 and DLX1 mRNA expression combined with traditional clinical risk factors. The aim of this prospective multi-institutional study was to evaluate the diagnostic accuracy of SelectMDx and its association with multiparametric magnetic resonance (mpMRI) when predicting PCa in prostate biopsies. Overall, 310 consecutive subjects were included. All patients underwent mpMRI and SelectMDx prior to prostate biopsy. SelectMDx and mpMRI showed sensitivity and specificity of 86.5% vs. 51.9%, and 73.8% vs. 88.3%, respectively, in predicting PCa at biopsy, and 87.1% vs. 61.3%, and 63.7% vs. 83.9%, respectively, in predicting csPCa at biopsy. SelectMDx was revealed to be a good predictor of PCa, while with regards to csPCa detection, it was demonstrated to be less effective, showing results similar to mpMRI. With analysis of strategies assessed to define the best diagnostic strategy to avoid unnecessary biopsy, SelectMDx appeared to be a reliable pathway after an initial negative mpMRI. Thus, biopsy could be proposed for all cases of mpMRI PI-RADS 4-5 score, and to those with Prostate Imaging-Reporting and Data System (PI-RADS) 1-3 score followed by a positive SelectMDx.