Assessing the Learning Curve of Holmium Laser Enucleation of Prostate (HoLEP). A Systematic Review

Kampantais, Spyridon; Dimopoulos, Panagiotis; Tasleem, Ali; Acher, Peter; Gordon, Karen A.; Young, A. W.

doi:10.1016/j.urology.2018.06.012

Cited by 107 publications

(78 citation statements)

References 34 publications

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“…A factor to be considered when evaluating the surgical outcomes of PVP or HoLEP is the surgeon’s expertise. Particularly regarding the learning curve of HoLEP, some literature has shown that HoLEP has a steep learning curve with a stationary state at 20–50 cases 21,22 . Accordingly, when the learning curve for the efficiency of HoLEP was assessed by enucleation efficiency (a ratio of retrieved tissue weight/enucleation time) in our study, the enucleation efficiency appeared to be stationary after approximately 50 cases (Supplementary Fig.…”

Section: Discussionmentioning

confidence: 99%

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Sun

Yoo

Park

et al. 2019

Sci Rep

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This study was aimed to compare serial long-term postoperative changes in quality-of-life (QoL) between photoselective-vaporization (PVP) using 120W-High-Performance-System and holmium-laser-enucleation (HoLEP) in benign-prostatic-hyperplasia (BPH) patients and to identify factors influencing the QoL improvement at the short-term, mid-term and long-term follow-up visits after surgery. We analyzed 1,193 patients with a baseline QoL-index ≥2 who underwent PVP (n = 439) or HoLEP (n = 754). Surgical outcomes were serially compared between the two groups at up to 60-months using the International-Prostatic-Symptom-Score (I-PSS), uroflowmetry, and serum PSA. We used logistic regression analysis to identify predictors of QoL improvement (a reduction in the QoL-index ≥50% compared with baseline) at the short-term (12-months), mid-term (36-months), and long term (60-months) follow-up after surgery. In both groups, the QoL-index was decreased throughout the entire follow-up period compared with that at baseline. There were no significant differences in postoperative changes from the baseline QoL-index between the two groups during the 48-month follow-up, except at 60-months. The degree of improvement in QoL at 60-months after HoLEP was greater than that after PVP. A lower baseline storage-symptom-subscore and a higher bladder-outlet-obstruction-index (BOOI) were independent factors influencing QoL improvement at the short-term. No independent factor influences QoL improvement at the mid- or long-term.

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Section: Discussionmentioning

confidence: 99%

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Sun

Yoo

Park

et al. 2019

Sci Rep

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“…A recent systematic review proposed that HoLEP had an acceptable learning curve of *25-50 cases. 4 Aquablation utilizes a user-friendly robotic software that is easy to learn after a single case. Furthermore, the software is combined with transrectal ultrasound guidance, 2 which urologists are familiar with by the end of residency training.…”

Section: Discussionmentioning

confidence: 99%

Aquablation for the Treatment of Benign Prostatic Hyperplasia in a Large Volume Prostate with an Intravesical Median Lobe

Ghiraldi

Ambinder

Son

et al. 2020

Journal of Endourology Case Reports

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Background: Aquablation is a relatively new minimally invasive technology for the treatment of benign prostatic hyperplasia (BPH) that has shown significant promise in its clinical efficacy and utility. Larger prostates or prostates with a median lobe are a common limitation to other minimally invasive treatment options. There is evidence that Aquablation maintains efficacy for larger prostates and prostates with an intravesical median lobe. Herein, we describe 3-month follow-up results for a patient who underwent Aquablation for a large prostate with a significant intravesical median lobe. Case: Our patient is a 72-year-old man with lower urinary tract symptoms secondary to BPH refractory to pharmacotherapy. Patient underwent Aquablation of the prostate, which was 110 cc in volume and had a large intravesical median lobe component. At 3-month follow-up patient had reduction in his AUA-SS from 21 to 12, improvement in uroflow from 8.2 to 16 mL/second, and improvement in postvoid residual from 90 to 13 mL. Conclusion: Aquablation has been shown to be efficacious for the treatment of BPH in patients with large prostates and intravesical median lobes. This case report further demonstrates effective treatment for patients who fit this profile.

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“…Moreover, the long learning curve is the major negative factor that hinders widespread use of this procedure to date [17]. The inexperience of the Surgeon elevates the risk of bleeding and UI after HoLEP because of long operation time, frequent intraoperative complications and inadequate enucleation.…”

Section: Discussionmentioning

confidence: 99%

Holmium Laser Enucleation of the Prostate With Virtual Basket Mode: Faster and Better Control on Bleeding

Bozzini

Maltagliati

Besana

et al. 2020

Preprint

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BACKGROUND: To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate with Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH).METHODS: This prospective randomized study enrolled consecutive patients with BPH to HoLEP (n = 100) or VB-HoLEP (n =100). We evaluated all patients preoperatively with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We evaluated also the patients at 3, 6 and 12 months after surgery with the use of maximum flow rate (Qmax), postvoid residual urine volume (PVR) and International Prostate Symptom Score (IPSS).RESULTS: We didn’t see significant difference in preoperative parameters between patients in each study arm. Compared with HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs 1.12 g/dL, P = .003) and had a more rapid operative time (57.33±29.71 vs 42.99±18.51 minutes, P = 0.04). HoLEP and VB-HoLEP had same catheterization time (2.2 vs 1.9 days, P = 0.45), irrigation volume (33.3 vs 31.7 L, P = 0.69), and hospital stay (2.8 vs 2.7 days, P = 0.21). During the follow-up of subsequent 12 months, we didn’t demonstrate a significant difference in IPSS, Qmax, PVR, and QOLS.CONCLUSION: HoLEP and VB-HoLEP both are efficient a safe procedure for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and to allow a faster procedure. However, procedures did not differ significantly in catheterization time, hospital stay, operation time and irrigation volume. No differences were demonstrated in QOLF, IPSS, Qmax and PVR through the post-surgery 12 months of follow-up.TRIAL REGISTRATION: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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Assessing the Learning Curve of Holmium Laser Enucleation of Prostate (HoLEP). A Systematic Review

Cited by 107 publications

References 34 publications

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes

Aquablation for the Treatment of Benign Prostatic Hyperplasia in a Large Volume Prostate with an Intravesical Median Lobe

Holmium Laser Enucleation of the Prostate With Virtual Basket Mode: Faster and Better Control on Bleeding

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