Background: To date, robotic surgery in urology is well established all over the world. The newest platform on the market is the HUGO™ RAS system, developed by Medtronic. In this paper we provide a brief description of the system and describe our system set-up and surgical approach with this new platform in our initial experience of robotic radical prostatectomy (RARP) series. Materials and methods: After an official training, seven consecutive patients affected by localized prostate cancer underwent RARP with HUGOTM RAS system at our Institution. A description of our surgical approach and docking setup is provided. Docking and console times were reported for all precedures together with main suggestions to facilitate the use of this new system at the beginning of the experience. Results: Our operating room setup has shown to be safe, effective, and easy replicable. During our series, operative times appeared to be easy reproducible and comparable to those obtained with daVinci system. No major system faults and conflicts between robotic arms were observed after the first procedure. Conclusions: Our surgical approach and system configuration for performing RARP with the new HUGO™ RAS system appears to be safe, efficient and easy reproducible.

Objective To determine in a large population of community‐dwelling incontinent patients the accuracy and determinants of pad count as a measure of urinary incontinence (UI), using data from a multicentre 48‐h pad test study. Materials and Methods Incontinent patients, who were provided with absorbent products for the period January 2012 to March 2016, volunteered to perform a 48‐h home‐based pad test and to fill in a diary with information on pad usage. Correlations between UI measures (48‐h pad count and pad weight gain, mean pad weight gain per pad) were calculated. Logistic regression analyses were conducted to investigate patient‐related and pad usage‐related factors influencing pad count. Results A total of 14 493 patients (median age 81 years) were included, with a total of 98 362 continence products used overall during the study period. The 48‐h pad count showed a weak correlation with 48‐h pad weight gain (R2 = 0.12; 0.19 for men and 0.11 for women) and mean pad weight gain per pad (R2 = −0.03). The weakest correlation was observed among patients using >6 pads/48 h (R2 = 0.02). A statistically significant negative association between pad absorption capacity and pad count was observed. Patients using products with a shaped and rectangular design had 34% and 40% higher propensity to use more pads than those using briefs (P < 0.001), respectively. Conclusions The results of this very large observational study confirmed that pad count is a poor measure of UI severity. Pad count only measured 12% of the variability of UI volume and was affected by several patient‐related and pad usage‐related factors. Consequently, pad count should not be used instead of the pad test as an objective measure of UI when an accurate evaluation is required for research or clinical purposes.

Objective To compare the efficacy of artificial urinary sphincter (AUS) vs retrourethral transobturator sling (RTS) in men with moderate post‐prostatectomy urinary incontinence (PPI) using propensity score‐matching analysis to enhance the validity of the comparison (Canadian Task Force classification II‐2). Patients and methods Consecutive men with moderate (3–5 pads/day) stress‐prevalent PPI were included if implanted with a RTS (TiLOOP® Male; pfm medical, Köln, Germany) or AUS (AMS800®; Boston Scientific, Boston, MA, USA) since July 2011 to December 2017 and with ≥12 months of follow‐up. Preoperative assessment included 24‐h pad usage, International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF), urethrocystoscopy, and urodynamics if indicated. Propensity score‐matching analysis was based on age, body mass index, Charlson Comorbidity Index, pad usage, previous radiotherapy, and urethrotomy. The primary outcome was at least ‘much improved’ response at 12‐months according to the Patient Global Impression of Improvement questionnaire, without additional PPI surgery or prosthesis explantation. Results Of 109 included patients, 70 patients were matched and the study groups were well balanced for the baseline matched variables. The median baseline 24‐h pad usage was four in both groups (P = 0.10), and median follow‐up was 51.2 months for AUS and 47.2 months (P = 0.5) for RTS patients. In the AUS and RTS cohorts, respectively, 33 (94.3%) and 24 (68.6%) patients achieved the primary outcome (P < 0.001), the 0–1 pad/day rates was 94.3% vs 68.6% (P = 0.012) at 12 months, and 91.4% vs 68.6% (P = 0.034) at last follow‐up. At the last follow‐up, the median 24‐h leakage volumes, median ICIQ‐SF scores and satisfaction rates were 0 vs 15 mL (P = 0.017), 4 vs 10 (P = 0.001), and 94.3% vs 68.6% (P = 0.012) in the AUS and RTS cohorts, respectively. There were no significant differences in overall rates of complications and re‐interventions, although Clavien–Dindo Grade III complications (n = 3) occurred only in the AUS group. At sensitivity analysis, the study was reasonably robust to hidden bias. Conclusion We found that AUS implantation significantly outperformed RTS in patients with moderate PPI for both subjective and objective outcomes.