For GPs

When robotic surgery is generally appropriate

• Localised prostate cancer where surgery has been chosen over active surveillance or radiotherapy - see robotic prostatectomy.
• Small renal masses (cT1) suitable for partial nephrectomy - see robotic partial nephrectomy.
• Larger renal tumours not amenable to nephron-sparing surgery - see robotic radical nephrectomy.
• Ureteropelvic-junction (UPJ) obstruction with symptoms, recurrent infection or progressive functional loss - see robotic pyeloplasty.
• Functioning or suspicious adrenal masses (generally >4 cm, growing, or hormonally active) - see robotic adrenalectomy.
• Muscle-invasive bladder cancer fit for radical cystectomy - see robotic cystectomy.

Useful pre-referral workup

Not essential, but makes the first consultation more productive:

• Prostate: PSA history (ideally three time points), DRE findings, mpMRI report with PI-RADS, biopsy histology with ISUP grade group if available, staging imaging if high risk (PSMA-PET).
• Kidney mass: four-phase renal CT or MRI, renal function (eGFR), haemoglobin, plain chest imaging.
• UPJ obstruction: renal tract ultrasound and MAG3 diuretic renogram; CT urogram if stone disease or mass is suspected.
• Adrenal mass: plasma free metanephrines or 24-hour urinary fractionated metanephrines, overnight 1 mg dexamethasone suppression test, aldosterone-to-renin ratio, dedicated adrenal CT with washout.
• Bladder cancer: cystoscopy findings, transurethral resection histology with detrusor muscle status, CT urogram, renal function.

How to refer

Urgent pathways

• Suspected phaeochromocytoma or symptomatic adrenal mass - phone the rooms directly for advice before any biopsy.
• Gross haematuria or visible mass on imaging - flag on the referral so triage can expedite cystoscopy and staging.
• Obstructed infected kidney - send to emergency; the rooms can discuss urgent nephrostomy or stent placement and onward definitive care.