Are we ready to embark on further regionalization of urological surgery across Canada?

As I was looking back on some of our CUAJ highlights from 2018, I was struck by the attention and thoughtfulness towards the quality of our care delivery explored in so many research articles, as well as the editorial commentaries, from authors around the globe, but particularly from those based in Canada. These ideas, laser-focused on barriers and potential solutions, spanned urological care delivered in disparate countries/regions; between teaching- and community-based hospitals; from quaternary care in centres of excellence to more commonplace (but nonetheless essential) urological care in our communities. Authors surveyed our collective adherence to guideline recommendations, the disparity of access and public funding across provinces, and the efficacy of multidisciplinary tumour boards, as well as patient experiences and satisfaction around complex cancer decisions, transitions of care, and other controversial topics, including mesh repairs for pelvic organ prolapse. This issue of the CUAJ is no exception, with a thoughtful article by Duplisea et al1 and the companion commentary by Rafael and Booth2 exploring shortfalls in the management of bladder cancer on both sides of the border. These articles offer real insight into an apparent efficacy-effectiveness gap within the urological community in its uptake of evidence-based recommendations such as neoadjuvant chemotherapy. Their call for enhancing infrastructure in order to determine and measure appropriate benchmarks for complex urological care seems well-justified