Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature. The commonest biopsy approaches are via the transperineal (TP) or transrectal (TR) routes. The former is considered more advantageous due to its negligible risk of post-procedural sepsis and reduced need for antimicrobial prophylaxis; the more recent development of local anaesthetic (LA) methods now makes this approach feasible in the clinic. Beyond this, several techniques are available, including cognitive registration, MRI–Ultrasound fusion imaging and direct MRI in-bore guided biopsy. Evidence shows that performing targeted biopsies reduces the number of cores required and can achieve acceptable rates of detection whilst helping to minimise complications and reducing pathologist workloads and costs to health-care facilities. Pre-biopsy MRI has revolutionised the diagnostic pathway for PCa, and optimising the biopsy process is now a focus. Combining MR imaging, TP biopsy and a more widespread use of LA in an outpatient setting seems a reasonable solution to balance health-care costs and benefits, however, local choices are likely to depend on the expertise and experience of clinicians and on the technology available.

Introduction. The placement of ring or band around the gastric tube might prevent the dilation after Laparoscopic Sleeve Gastrectomy (LSG). We describe the first randomized study comparing LSG and Laparoscopic Banded Sleeve Gastrectomy (LBSG).Material and Method. Fifty obese patients were enrolled in the study between January 2014 and January 2015. We analysed differences in operative time, complication rate, mortality, and BMI between the two groups over a period of 12 months.Results. Twenty-five patients received LSG (group A) and 25 LBSG (group B). The mean preoperative BMI was47.3±6.58 kg/m²and44.95±5.85 kg/m², respectively, in the two groups. There was no statistical relevant difference in operative time. No intraoperative complications occurred. Mean BMI registered after 3, 6, and 12 months in groups A and B, respectively, were37.86±5.72 kg/m²and37.58±6.21 kg/m²(p=0.869),33.64±6.08 kg/m²and32.03±5.24 kg/m²(p=0.325), and29.72±4.40 kg/m²and27.42±4.47 kg/m²(p=0.186); no statistical relevant difference was registered between the two groups.Conclusion. LBSG is a safe and feasible procedure. The time required for the device positioning did not influence significantly the surgical time. The results of bodyweight loss did not document any statistically significant differences among the two groups, even though LBSG group showed a mean BMI slightly lower than that of the control group.

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19–0.97; I² = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43–0.65; I² = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI −0.00; 1.15; I² = 96.52), while the pooled SMD in hospitalization days was −1.35 (95% CI −1.87; −0.82; I² = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.

Background: Numerous continence-sparing radical prostatectomy techniques have been developed to enhance postoperative early continence recovery; however, evidence regarding the best approach remains controversial. The objectives are: to provide a critical appraisal of various prostatectomy techniques, based on the evidence of quality-assessed randomised control trials (RCT); to summarise the immediate continence and the early continence reported; to propose a new standardisation for continence outcomes reporting. Methods: Data acquired from five medical registries were reported to PRISMA standards. Evidence from published, English, full-text RCTs reporting postoperative urinary continence outcomes within 6 months from surgery were included. Heterogeneity of surgical techniques and continence definitions did not allow a meta-analysis. All RCTs were critically appraised and quality assessed. Results: 39 RCTs were included: 19/39 studies were low-quality RCTs, presenting small cohort, monocentric or single-surgeon data. The best RCT-supported evidence is in favour of RARP compared to LRP and of the Retzius-sparing technique over the traditional prostatectomy. Other techniques such as bladder neck and puboprostatic ligament preservation, posterior reconstruction with or without combination of anterior suspension technique and nerve-sparing approach seem to enhance EC. Oppositely, the endopelvic fascia preservation, bladder neck mucosa eversion/plication/slings and the selective ligature of dorsal venous complex were not significantly associated to early continence improvements. RCTs are lacking on pubovesical complex-sparing, seminal vesicle preservation, anterior reconstruction of the puboprostatic collar, musculofascial reconstruction, dorsal venous complex suspension to the periosteum of the pubic bone techniques. Conclusions: RARP and Retzius-sparing have high-quality evidence supporting their ability to enhance postoperative EC recovery. Nerve-sparing, bladder neck and puboprostatic ligament preservation may contribute to better EC recovery, although the evidence level is low. Further multicentre RCTs are needed to establish the optimal combination of standard surgical techniques. A new continence outcome-reporting standardisation was proposed.