Our consensus statements demonstrate a set of criteria that are required for the practical dissemination of consistently high-quality prostate mpMRI as a diagnostic test before biopsy in men at risk.

Analysis 1.4. Comparison 1 Robotic-assisted laparoscopic versus open radical cystectomy, Outcome 4 Transfusion rate. Analysis 1.5. Comparison 1 Robotic-assisted laparoscopic versus open radical cystectomy, Outcome 5 Hospital stay.. Analysis 1.6. Comparison 1 Robotic-assisted laparoscopic versus open radical cystectomy, Outcome 6 Quality of life. Analysis 1.7. Comparison 1 Robotic-assisted laparoscopic versus open radical cystectomy, Outcome 7 Positive margin.

Objective To evaluate the clinical and financial implications of a decade of prostate biopsies performed in the UK National Health Service (NHS) through the transrectal (TR) vs the transperineal (TP) route. Methods We conducted an evaluation of the TR vs the TP biopsy approach in the context of 28 days post‐procedure complications and readmissions. A secondary evaluation of burden of expenditure in NHS hospitals over the entire decade (2008–2019) was conducted through examination of national Hospital Episode Statistics (HES) data. Results In this dataset of 486 467 prostate biopsies (387 879 TR and 98 588 TP biopsies), rates of infection and sepsis were higher for the TR compared to the TP cohort (0.53% vs 0.31%; P < 0.001, confidence interval 99% ). Rates of sepsis have more than doubled for TR biopsies in the last 2 years compared to the previous decade (1.12% vs 0.53%). Infective complications were the main reasons for readmissions in the TR cohort, whereas urinary retention was the predominant reason for readmission in the TP cohort. Over the last decade, non‐elective (NEL) readmissions seem higher for the TP group; however, in the last 2 years these have reduced compared to the TR group (3.54% vs 3.74%). The cost estimates for NEL readmissions for the entire decade were £33,589,527.00 and £7,179,926.00 respectively, for TR and TP cohorts (P < 0.001). Estimated costs per patient readmission were £2,225.00 and £1,758.00 in the TR and TP groups (P < 0.001). Conclusions Evaluation of nearly half a million prostate biopsies in the NHS over the entire decade gives sufficient evidence for the distinct advantages of the TP route over the TR route in terms of reduced infections and burden of expenditure. In addition, there is a potential for savings both in upstream and downstream costs if biopsy is performed under a local anaesthetic.

Objective• To evaluate the incidence of lower limb compartment syndrome (LLCS) in robot-assisted radical prostatectomy (RARP) and the prevalence of risk factors in patients with LLCS. Methods• Data were collected from 17 UK robotic surgery institutions for a multicentre analysis.• Data were used to calculate the incidence of LLCS and the prevalence of risk factors. Results• A total of 3110 RARPs were performed by 17 institutions between 2004 and 2011.• There were nine cases of LLCS, giving an incidence of 0.29%. Seven of these required fasciotomy.• The prevalence of risk factors was as follows: console time >4 h in 8/9 cases, early learning curve (<20 cases) in 3/9 cases; obesity (BMI >30 kg/m 2 ) in 5/9 cases; and peripheral vascular disease in 2/9 cases. One patient with LLCS was positioned incorrectly. Conclusions• The serious complication LLCS occurs in RARP but has a low incidence.• Long operating times, surgical inexperience, poor patient positioning, obesity and vascular disease appear to be risk factors.

ObjectivesTo evaluate postoperative health resource utilisation and secondary care costs for radical prostatectomy and partial nephrectomy in National Health Service (NHS) hospitals in England, via a comparison of robot-assisted, conventional laparoscopic and open surgical approaches. Patients and MethodsWe retrospectively analysed the secondary care records of 23 735 patients who underwent robot-assisted (RARP, n = 8 016), laparoscopic (LRP, n = 6 776) or open radical prostatectomy (ORP, n = 8 943). We further analysed 2 173 patients who underwent robot-assisted (RAPN, n = 365), laparoscopic (LPN, n = 792) or open partial nephrectomy (OPN, n = 1 016). Postoperative inpatient admissions, hospital bed-days, excess bed-days and outpatient appointments at 360 and 1 080 days after surgery were reviewed. ResultsPatients in the RARP group required significantly fewer inpatient admissions, hospital bed-days and excess bed-days at 360 and 1 080 days than patients undergoing ORP. Patients undergoing ORP had a significantly higher number of outpatient appointments at 1 080 days. The corresponding total costs were significantly lower for patients in the RARP group at 360 days (£1679 vs £2031 for ORP; P < 0.001) and at 1 080 days (£3461 vs £4208 for ORP; P < 0.001). In partial nephrectomy, Patients in the RAPN group required significantly fewer inpatient admissions and hospital bed-days at 360 days compared with those in the OPN group; no significant differences were observed in outcomes at 1 080 days. The corresponding total costs were lower for patients in the RAPN group at 360 days (£779 vs £1242 for OPN, P = 0.843) and at 1 080 days (£2122 vs £2889 for ORP; P = 0.570). For both procedure types, resource utilisation and costs for laparoscopic surgeries lay at the approximate midpoint of those for robot-assisted and open surgeries. ConclusionOur analysis provides compelling evidence to suggest that RARP leads to reduced long-term health resource utilisation and downstream cost savings compared with traditional open and laparoscopic approaches. Furthermore, despite the limitations that arise from the inclusion of a small sample, these results also suggest that robot-assisted surgery may represent a cost-saving alternative to existing surgical options in partial nephrectomy. Further exploration of clinical cost drivers, as well as an extension of the analysis into subsequent years, could lend support to the wider commissioning of robot-assisted surgery within the NHS.