Prospective analysis of the learning curve in holmium laser enucleation of the prostate (HoLEP): A 125 case series

Abstract

Objective

The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate (HoLEP) in 125 consecutive cases.

Materials and methods

Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by HoLEP were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test.

Results

Surgical time decreased progressively: 92 min. (Q1), 65 min. (Q2), 54 min. (Q3), 45 min. (Q4) and 50 min. (Q5) (p < 0.001). Enucleation rate gradually increased: 1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min (Q4) and 2.74 g/min (Q5) (p < 0.001). There were no differences in enucleated weight (Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g) (p = 0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p > 0.05). Time to continence recovery was similar in quintiles 1–4 (23, 27, 21, 20 days) and shorter in quintile 5 (3.5 days) (p < 0.001).

Conclusion

The initiation of a HoLEP program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.