用钬激光进行前列腺核化的学习曲线前瞻性分析：125例系列

IF 1.2 4区医学 Q3 UROLOGY & NEPHROLOGY

Actas urologicas espanolas Pub Date : 2025-04-01 DOI:10.1016/j.acuro.2025.501705

L.E. Ortega Polledo , E. García Rico , A. Sánchez Pellejero , G.F.J. Bianchini Hernández , A. Sanchís Bonet , J. Gómez Rivas , I. Galante Romo , J. Moreno Sierra , B. Miñana , S. Ahyai , S. Alonso y Gregorio

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引用次数: 0

摘要

目的评价外科医生学习曲线在连续125例钬激光前列腺摘除手术中的有效性和安全性。材料与方法记录125例钬激光前列腺摘除患者的术前基线特征、功能结局、手术时间及并发症。将样本分成五分位数（25例/组），采用方差分析、Kruskal-Wallis H检验、卡方检验和似然比检验进行统计分析。结果手术时间依次缩短：92 min （Q1）、65 min （Q2）、54 min （Q3）、45 min （Q4）、50 min (Q5) (p <；0.001)。去核速率逐渐增加：1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min （Q4）和2.74 g/min (Q5) (p <；0.001)。在去核重量（Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g）（p = 0.21），住院时间（中位1.12天），膀胱导尿（平均1.51天），手术内和术后并发症或尿道狭窄（5.6%）(p >；0.05)。1至4分位数（分别为23、27、21和20天）的失禁恢复时间相似，而5分位数（3.5天）的失禁恢复时间较短(p <；0.001)。结论：在训练结束后开始钬激光前列腺摘除术具有低发病率和良好的功能预后。从学习曲线开始，该技术的效率就呈现出线性和一致的增长，在25例手术后显著减少了手术时间。

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Análisis prospectivo de la curva de aprendizaje en enucleación prostática con láser de holmio: serie de 125 casos

Objective

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

Materials and methods

Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by holmium laser enucleation of the prostate 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 to 4 (23, 27, 21 and 20 days, respectively) and shorter in quintile 5 (3.5 days) (p < 0.001).

Conclusions

The initiation of a holmium laser enucleation of the prostate 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.

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来源期刊

Actas urologicas espanolas UROLOGY & NEPHROLOGY-

CiteScore

1.90

自引率

0.00%

发文量

审稿时长

46 days

期刊介绍： Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided.