Journal of endourology最新文献

{"title":"A Feasibility Study on the Efficacy and Safety of a Novel Tip-Flexible Suction Ureteral Access Sheath Combined with Flexible Ureteroscopic Lithotripsy for Treating Kidney Stones ≥30 mm.","authors":"Wenwei Chen, Kaixin Lu, Changyi Liu, Jinfeng Weng, Rui Gao","doi":"10.1089/end.2024.0283","DOIUrl":"https://doi.org/10.1089/end.2024.0283","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate the efficacy and safety of a novel tip-flexible suction ureteral access sheath (NTFS-UAS) combined with flexible ureteroscopic lithotripsy (FURS) for treating kidney stones ≥30 mm in a large cohort. <b><i>Methods:</i></b> The clinical data of 206 patients with renal calculi ≥30 mm treated by NTFS-UAS combined with FURS from June 2021 to September 2023 were analyzed retrospectively. The outcomes under investigation encompassed demographic information, stone-related characteristics, operative time, stone-free rates (SFRs), and postoperative complications. <b><i>Results:</i></b> The median operation duration was 110 minutes (interquartile 84.00-146.25 minutes). Immediate and 1-month SFRs were 83.98% and 85.44%, respectively. Multivariate analysis revealed five risk factors independently affecting stone clearance rate: stone size (≥50 mm, odds ratio [OR] = 3.826, <i>p</i> = 0.039), stone number (multiple: OR = 8.745, <i>p</i> = 0.015), stone location (multiple calyces: OR = 10.371, <i>p</i> = 0.045; lower calyx: OR = 9.615, <i>p</i> = 0.047), severe hydronephrosis (OR = 8.338, <i>p</i> = 0.002), and the Resorlu-Unsal scoring system (RUSS) score (6-7: OR = 10.829, <i>p</i> = 0.009; 4-5: OR = 4.223, <i>p</i> = 0.008). The incidence of Clavien-Dindo grade II-III complication was 5.82%. Positive preoperative urine culture (OR = 9.533, <i>p</i> = 0.012) and RUSS score (6-7: OR = 25.678, <i>p</i> = 0.026; 4-5: OR = 11.444, <i>p</i> = 0.038) were identified as the most important variables that may contribute to the development of high-grade postoperative complications. <b><i>Conclusion:</i></b> NFTS-UAS combined with FURS achieved satisfactory outcomes with good efficacy and safety for treating large renal stones ≥30 mm, and it can be utilized as an effective treatment option for patients having contraindications or preference against percutaneous nephrolithotomy. In addition, clinical factors, such as stone size, severe hydronephrosis, positive preoperative urine culture, and RUSS stone score that likely affected the outcomes of NFTS-UAS, should be fully taken into account when the surgeon performing FURS using NFTS-UAS.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Ultrasonography-Guided Percutaneous Nephrolithotomy for the Management of Pediatric Urolithiasis.","authors":"Yang Hong, Luping Yu, Xiaobo Huang, Lizhe An, Liulin Xiong, Tao Xu, QingQuan Xu","doi":"10.1089/end.2023.0771","DOIUrl":"https://doi.org/10.1089/end.2023.0771","url":null,"abstract":"<p><p><b><i>Objectives:</i></b> This study aims to assess the outcomes of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (PCNL) in the treatment of pediatric urolithiasis. <b><i>Methods:</i></b> A retrospective analysis was conducted on 176 patients with pediatric renal and upper ureteral lithotripsy who underwent PCNL between August 2006 and July 2022. The cohort comprised 110 men and 66 women, with ages ranging from 6 months to 16 years. Postoperative stone clearance was evaluated using kidney, ureter, and bladder radiograph or US, categorizing stones less than 4 mm as clear. Postoperative complications were graded according to the Clavien-Dindo classification, with grades I and II considered minor and III and IV classified as major. <b><i>Results:</i></b> Among the patients, 152 underwent unilateral renal operation, whereas 24 underwent bilateral renal operation. The average operation duration was 67.41 minutes (range: 15-195 minutes). The mean duration of nephrostomy tube removal was 3.79 days, and the mean postsurgical hospital stay was 5.97 days. A total of 146 patients experienced a decrease in hemoglobin concentration post operation, with an average drop of 10.57 g/dL (range: 0.5-37.8 g/dL). Initial stone-free rate (SFR) was achieved in 85.5% (171/200) of cases, and the final SFR was 92.50% (185/200). The postoperative rate of minor complications was 8.54% (17/199), whereas major complications occurred in 12.06% (24/199) of cases. During the 6-month to 11-year follow-up period, 19 patients presented with combined stones, and of these 4 presented with ipsilateral stone recurrence who underwent PCNL treatment. Calcium oxalate was identified as the most common stone component. <b><i>Conclusions:</i></b> US-guided minimally invasive PCNL demonstrated excellent SFR and an acceptable complication rate in the management of pediatric urolithiasis. Furthermore, it offers the advantage of minimizing potential risks associated with radiation exposure during the procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142620871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Holmium:YAG, Pulsed-Thulium:YAG and Thulium Fiber Lasers for Urinary Stone Ablation. <i>In Vitro</i> Study.","authors":"Alba Sierra, Frederic Panthier, Esther Castillo, Asier Mercadé, Lluís Peri, Antonio Alcaraz, Olivier Traxer, Juan Manuel López, Maria Pilar Luque","doi":"10.1089/end.2024.0349","DOIUrl":"10.1089/end.2024.0349","url":null,"abstract":"<p><p><b><i>Objective:</i></b> To evaluate the ablation speed (AS), laser efficiency and direct thermal lesions during urinary stone lithotripsy with the current available laser technologies: Holmium:YAG (Ho:YAG), pulsed-Thulium:YAG (p-Tm:YAG) and thulium fiber laser (TFL) <i>in vitro</i> using different laser settings. <b><i>Materials and Methods:</i></b> Ho:YAG, p-Tm:YAG, and TFL laser system were used in an <i>in vitro</i> ureteral model with a volume of 125 mm³ Begostone. The following parameters were tested across all laser devices: 0.6J/10 Hz (6 W), 0.6 J/20 Hz (12 W), 1.5 J/10 Hz (15 W), and 1.5 J/20 Hz (30 W), employing short pulse width for all lasers and long pulse width for Ho:YAG and p-Tm:YAG. Ten participants conducted the experimental setup during 3-minutes laser on time, combining the laser technology, settings, and pulse widths, with a total of 20 different combinations. The efficiency, AS and ureteral damage resulting from each intervention were analyzed. <b><i>Results:</i></b> p-Tm:YAG and TFL demonstrated significantly higher efficiency compared with Ho:YAG (0.049 ± 0.02 Δgr/KJ and 0.042 ± 0.01 Δgr/KJ <i>vs</i> 0.029 ± 0.01 Δgr/KJ; <i>p</i> < 0.05). In all laser sources, as the power increases, the AS also increases (<i>p</i> < 0.05). Furthermore, only at high-energy settings (1.5 J) higher frequency led to increase AS (<i>p</i> < 0.05). Both, p-Tm:YAG and TFL exhibited higher AS compared to Ho:YAG (0.64 ± 0.33 Δgr/s and 0.62 ± 0.31 Δgr/s <i>vs</i> 0.44 ± 0.22 Δgr/s; <i>p</i> < 0.05). Regarding ureteral injuries, as the power increases, there is a higher chance of ureteral damage (<i>p</i> = 0.031). No differences were observed between laser technologies (<i>p</i> = 0.828). <b><i>Conclusions:</i></b> Both, p-Tm:YAG and TFL exhibited superior performances during laser lithotripsy compared with Ho:YAG, as they demonstrated higher efficiency and ablation speed. Thermal damage did not appear to be associated with specific laser equipment, but higher grades of lesions are described by increasing power.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1209-1216"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Blacklight Illumination Improve Speed and Accuracy of Foot Pedal Activation in the Low-Light Operating Room?","authors":"Gabriel E Martin, Hyelin You, Jonathan Maldonado, Andrew Krause, Akin S Amasyali, Daniel Peverini, D Daniel Baldwin, Cayde Ritchie, Zhamshid Okhunov, D Duane Baldwin","doi":"10.1089/end.2024.0034","DOIUrl":"10.1089/end.2024.0034","url":null,"abstract":"<p><p><b><i>Background:</i></b> Urologists frequently activate foot pedals in a low-light operating room (OR). Pedal activation in low-light conditions poses the potential for incorrect pedal activation, potentially leading to increased radiation exposure, patient burns, or OR fires. This study compares speed, accuracy, dark adaptation, and surgeon preference for pedal activation in 4 lighting conditions. <b><i>Materials and Methods:</i></b> During a simulated percutaneous nephrolithotomy (PCNL), pedals for C-arm, laser, and ultrasonic lithotripter (USL) were randomized to 3 different positions. Urology attendings, residents, and medical students activated pedals in a randomized order in 4 settings: a dark OR with no illumination, an OR with overhead illumination, a dark OR with glowstick illumination, and a dark OR with blacklight illumination. Endpoints included pedal activation time; number of attempted, incomplete, and incorrect activations; dark adaptation; and subjective pedal preference. ANOVA was used for analysis with <i>p</i> < 0.05 considered significant. <b><i>Results:</i></b> In our study with 20 participants, the mean pedal activation times were significantly faster when using glowstick illumination (6.77 seconds) and blacklight illumination (5.34 seconds) compared with the no illumination arm (8.47 seconds, <i>p</i> < 0.001). Additionally, individual pedal activations for the C-arm, laser, and USL were significantly faster with glowstick and blacklight illumination compared with a dark OR (<i>p</i> < 0.001 for all). The blacklight illumination arm demonstrated decreased attempted (0.30 vs. 3.45, <i>p</i> < 0.001), incomplete (1.25 vs. 7.75, <i>p</i> < 0.001), and incorrect activations (0.35 vs. 1.25, <i>p</i> < 0.001) compared with the dark setting, while demonstrating no difference compared with having room lights on. Dark adaptation was significantly improved with blacklight illumination compared with having the room lights on (134.5 vs. 140.5 luminance, <i>p</i> < 0.001). All participants (100%) preferred illuminated pedals compared with the dark OR, with 90% favoring the blacklight illumination. <b><i>Conclusions:</i></b> During a simulated PCNL, blacklight illumination significantly improved accuracy and efficiency of pedal activation compared with the conventional dark OR, while maintaining the surgeon's dark adaptation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1201-1208"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of External Sphincter Grading after Early Apical Release Holmium Laser Enucleation of the Prostate on Postoperative Stress Urinary Incontinence.","authors":"Daniel J Heidenberg, Christopher Ballantyne, Mouneeb M Choudry, Mimi Nguyen, Mitchell R Humphreys, Scott M Cheney","doi":"10.1089/end.2024.0215","DOIUrl":"10.1089/end.2024.0215","url":null,"abstract":"<p><p><b><i>Background:</i></b> Postoperative stress urinary incontinence (SUI) after Holmium Laser Enucleation of the Prostate (HoLEP) has improved with the early apical release (EAR) technique. However, some patients develop SUI despite using EAR HoLEP. The aim of this study is to investigate whether a novel classification of the external sphincter is correlated with postoperative SUI. <b><i>Methods:</i></b> The data of 98 patients who underwent EAR HoLEP for benign prostatic hyperplasia were prospectively analyzed. We propose a novel endoscopic classification of external sphincter appearance after HoLEP graded from 0 (best preserved) to 3 (most degraded). Patients were followed for 6 months postoperatively and administered validated questionnaires. A logistic regression was performed to compare moderate SUI rates at sphincter grade 3, controlling for age, obesity, catheter dependency, and grams resected at 6 weeks and 3 months. <b><i>Results:</i></b> The sphincter grades included 6 grade 0, 47 grade 1, 30 grade 2, and 15 grade 3. Patients were divided into a group without SUI (<i>n</i> = 51), and a group with SUI (<i>n</i> = 47) at 6 weeks postoperatively by International Consultation on Incontinence Questionnaire (ICIQ). Patients with reported SUI on ICIQ were more likely to have sphincter grades ≥2 at 6 weeks (p= 0.001) and 3 months (<i>p</i> < 0.0001). At 6 months, persistent SUI was associated with sphincter grade 3 (<i>p</i> < 0.0001). Logistic regression demonstrated that sphincter grade 3 was associated with clinically significant SUI at 3 months (<i>p</i> < 0.01). <b><i>Conclusions:</i></b> Lower sphincter grades are associated with improved return of continence after EAR HoLEP.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1121-1127"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zero-Intrarenal Pressure Percutaneous Nephrolithotomy for One-Stage Treatment of Non-Acute Infectious Calculous Pyonephrosis: A Strategy to Avert Sepsis.","authors":"Ying-Tong Zuo, Tong-Zu Liu, Bing Li, Sheng Li, Yong-Zhi Wang, Ping Chen, Xing-Huan Wang, Zhong-Hua Wu","doi":"10.1089/end.2024.0115","DOIUrl":"10.1089/end.2024.0115","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> To evaluate the efficacy and safety of a novel zero-intrarenal pressure (IRP) percutaneous nephrolithotomy (PCNL) technique for one-stage treatment of non-acute infectious calculous pyonephrosis. <b><i>Patients and Methods:</i></b> This retrospective study analyzed 12 patients (4 males, 8 females; mean age 56.4 years) who underwent zero-IRP PCNL. The technique utilized a double-sheath vacuum suction system, with the outer sheath allowing for gravity irrigation and the inner sheath facilitating continuous suction. Keeping the height of gravity perfusion at the level of the kidney inherently prevented high IRP and achieved zero-IRP PCNL, even when stone fragments obstructed the suction channel. <b><i>Results:</i></b> The procedure demonstrated a high initial stone-free rate of 75%, improving to 91.7% after 1 month. The average operative time was 50.7 minutes. The mean hemoglobin drop was 6.1 g/L, managed without transfusions. Complications were minimal, with low-grade fever in two patients. No significant intraoperative or postoperative complications, such as sepsis, were noted. <b><i>Conclusions:</i></b> The zero-IRP PCNL technique, characterized by its double-sheath vacuum suction system and zero-pressure gravity perfusion, shows promise in safely and effectively managing non-acute infectious calculous pyonephrosis. Preliminary results are encouraging, but further research with larger sample sizes is essential for broader clinical validation.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1128-1133"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Postoperative Outcomes and Analgesic Requirements of Single-Port <i>vs</i> Multi-Port Robotic Assisted Radical Cystectomy\" by Fang, et al.","authors":"Hong-Wei Jiao, Xiao-Yue Feng","doi":"10.1089/end.2024.0515","DOIUrl":"10.1089/end.2024.0515","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"e1237-e1238"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optilume^® Drug-Coated Balloon May Lower the Re-Treatment Rate Postintervention for Challenging Urethral Stricture Disease in Long-Term Follow-Up: A Prospective Cohort Study.","authors":"Zein Alhamdani, Sean Ong, Wenjie Zhong, Peter Chin","doi":"10.1089/end.2024.0318","DOIUrl":"10.1089/end.2024.0318","url":null,"abstract":"<p><p><b><i>Background:</i></b> Urethral stricture disease is a common and at times unsatisfying condition that can lead to complications severely impacting a patient's quality of life (QOL). Open urethroplasty remains the gold standard treatment, however it is an invasive and highly specialized procedure. Strictures between 2 and 4 cm in length have been shown to recur at a rate of 50% within 12 months, a rate that typically decreases with each subsequent treatment. The Laborie Optilume drug-coated balloon (DCB) is the first of its kind developed for adjunct treatment of urethral strictures in men. The DCB initially treats the stricture through balloon dilatation and subsequently aims to prevent recurrence via the localized application of Paclitaxel. Our study assesses the safety and efficacy of the DCB in an Australian population with strictures exceeding 2 cm, who have undergone at least two prior procedures for urethral stricture disease. <b><i>Methods:</i></b> Patients were prospectively recruited from November 2019 to September 2021. International prostate symptom score (IPSS), IPSS QOL, and voiding parameters were collected at baseline, and again at 1, 6, 12, and 18 months. The DCB was applied by a single consultant urologist under rigid cystoscope with shallow direct vision internal urethrotomy with a cold knife prior to application of the DCB. <b><i>Results:</i></b> Seventeen patients were recruited with an average of 7.7 prior urethral procedures for recurrent stricture disease. In total, 76% were stricture free at 30 months follow-up. There were improvements in almost all parameters including max flow, average flow, IPSS, and IPSS QOL scores at 12 and 24 months. There were no complications. <b><i>Conclusion:</i></b> The DCB is a safe and effective method at reducing the rates of recurrence for high-risk stricture disease and can delay or prevent the need for urethroplasty in what remains a very challenging cohort of patients.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1192-1200"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to: Fu-Xiang Lin, Yi Yu, Zhan-Ping Xu Letter to Editor: Unveiling the Crystal Clear: Cone Beam Computed Tomography's Role in Enhancing PCNL Outcomes and the Path Forward.","authors":"Emanuela Altobelli, Riemer Kingma, Rianne Mors, Mieke T J Bus, Igle J de Jong, Stijn Roemeling","doi":"10.1089/end.2024.0452","DOIUrl":"10.1089/end.2024.0452","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"e1241-e1242"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Learning Curve for Holmium Laser Enucleation of the Prostate: A Single-Center Analysis of Surgical And Functional Outcomes.","authors":"Francesco Ditonno, Alberto Bianchi, Francesca Fumanelli, Claudio Brancelli, Sarah Malandra, Riccardo Rizzetto, Matteo Balzarro, Emanuele Rubilotta, Riccardo Autorino, Riccardo Bertolo, Alessandro Veccia, Alessandro Antonelli","doi":"10.1089/end.2024.0422","DOIUrl":"10.1089/end.2024.0422","url":null,"abstract":"<p><p><b><i>Background:</i></b> To report the surgical and functional outcomes of the holmium laser enucleation of the prostate (HoLEP) surgical program implemented at a high-volume tertiary referral center and to estimate the learning curve (LC) duration for this surgical procedure. <b><i>Methods:</i></b> Data of all consecutive patients undergoing HoLEP at the University of Verona between June 2022 and April 2024 were retrieved from a prospectively maintained institutional database of patients undergoing benign prostatic hyperplasia (BPH) surgical treatment. The primary endpoint was functional outcomes evaluation during the surgeons' LC. The secondary endpoint was to define the surgical LC for HoLEP. A multivariable test of means was performed to compare functional outcomes at different time points. After adjusting for potential confounders (age, preoperative pharmacotherapy, and prostate volume), multivariable linear regression models were fitted to evaluate the effect of experience on operative time (OT) and enucleation efficiency. To assess LCs for HoLEP surgery, the non-risk-adjusted cumulative sum (CUSUM) method was used. <b><i>Results:</i></b> A statistically significant improvement in International Prostate Symptoms Score (IPSS) score, delta% IPSS score, IPSS quality of life (IPSS-QoL) score, and delta% IPSS-QoL score was observed over the study period. Furthermore, the incidence of irritative symptoms (<i>p</i> < 0.001) and stress incontinence (<i>p</i> = 0.01) significantly decreased over time, with a 12-month incidence of 8.4% and 9.5%, respectively. A statistically significant association between experience and both OT and enucleation efficiency was observed in multivariable linear regression analysis. The CUSUM chart for OT and enucleation efficiency showed a steep initial upward/downward trend of ∼50 cases each, and a plateau until ∼100 procedures are reached, where the breakpoint is recognized for both variables and where the CUSUM curve goes below the locally weighted scatterplot smoothing curve in the corresponding observed-expected CUSUM plot. <b><i>Conclusions:</i></b> HoLEP represents an effective treatment for BPH, demonstrating significant improvement in BPH-related symptoms over the study period, despite the considerable LC of ∼50 cases associated with the procedure.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"1226-1233"},"PeriodicalIF":2.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}