Developing team members' nontechnical skills and providing organizational support are necessary to help ensure that MDTs are delivering high-quality, patient-centered care. Recording dissent in decision making within the MDT is an important element, which should be defined further. The question of how best to represent the patient in MDT meetings also requires further exploration.

stone size from a large contemporary cohort adjusting for key potential confounders. We anticipate that these data will aid clinicians managing patients with acute ureteric colic and help guide management decisions and the need for intervention.

ContextAcute testicular torsion is a common urological emergency. Accepted practice is surgical exploration, detorsion and orchidopexy for a salvageable testis. ObjectiveTo critically evaluate methods of orchidopexy and their outcomes with a view to determining optimal surgical technique. Evidence AcquisitionThe review protocol was published via PROSPERO [CRD42016043165] and conducted in accordance with PRISMA. EMBASE, MEDLINE and CENTRAL databases were searched using terms: 'orchidopexy', 'fixation', 'exploration', 'torsion', 'scrotum' and variants. Article screening was performed by two reviewers independently. The primary outcome was retorsion rate of the ipsilateral testis following orchidopexy. Secondary outcomes included testicular atrophy and fertility. Evidence SynthesisTo our knowledge, this is the first systematic review on this topic. The search yielded 2257 abstracts. Five studies (n=138 patients) were included.All five techniques differed in incision and/or type of suture and/or point(s) of fixation. Postoperative complications were reported in one study and included scrotal abscess in 9.1% and stitch abscess in 4.5%. The contralateral testis was fixed in 57.6% of cases.Three studies reported follow-up duration (range 6-31 weeks). No study reported any episodes of ipsilateral retorsion. In the studies reporting ipsilateral atrophy rate, this ranged from 9.1-47.5%. Fertility outcomes and patient reported outcome measures were not reported in any studies.

A radical cystectomy (RC) with pelvic lymph node dissection (PLND) is the gold standard for the management of the appropriately selected patient with muscle invasive bladder cancer (MIBC) and non-muscle invasive bladder cancer (NMIBC)/carcinoma in situ (CIS) who fail appropriate intravesical therapy. In the last decade, Robotic Radical Cystectomy (RRC) is being performed in a large number of international Centre's with the published advantages of decreased blood loss, improved post-operative convalescence and earlier initiation of adjuvant therapy 1 when compared to open cystectomy (OC). Current literature indicates that a RC is equivalent to OC from the oncological perspective. An OC is associated with high rates of morbidity (19-64%) or mortality (6-11%), although there is a wide variation in current literature. 1-11 A RRC is perhaps just one modality in a raft of measures to try reducing mortality and morbidity of a cystectomy.To the Robotic Urological Surgeon, a RRC comes with numerous specific challenges. Questions that arise at the time of commencing a RRC include the learning curve of the procedure, learning steps to enhances ones speed to perform the procedure efficiently and safely, level of lymphnode dissection, whether one should embark of performing an intracorpealileal conduit or neobladder formation and the cost of commencing a RRC service. The patient's postoperative management is the most important step to ensure that the post-operative complications are kept to a minimum using a multi-disciplinary team (MDT) approach.In current literature high volume centers with experienced surgeons have reported patient outcomes that are acceptable from the perspective of extended pelvic lymph node dissection, positive surgical margin rates and highlight that patients are not being compromised from the surgical perspective in undergoing a RC. 2 The learning curve of a RRC is not as clearly defined in comparison to Robotic Radical Prostatectomy (RRP). Before commencing aRRC it is important to be proficient and familiar with robotic pelvic surgery. Most robotic surgeons are proficient in RRP before embarking on performing independent RRC. Hayn et al. 3 have indicated that an acceptable level of proficiency to perform a RRC is established after the 30 th case by measuring post-operative parameters such as operative time, lymph node yield (LNY), estimated blood loss (EBL), and margin positivity. At our center we commenced performing RC after performing 150 Robotic RRP. We would strongly recommend that a robotic urological surgeon who is keen to commence Robotic RC should be proficient in robotic RRP and in performing an extended pelvic lymph node dissection (EPLND). A well-trained Robotic Team consisting of the lead experience console surgeon, experienced assistant, nursing staff and an experience anesthetist is essential for the commencement of a RRC program. The techniques that a team needs to develop to aid in improving intra-operative times including a fast docking/ undocking time, piggyback techniques for por...