Introduction of a New Score to Assess Surgical Efficiency in Holmium Laser Enucleation of the Prostate

Abstract

Introduction: While holmium laser enucleation of the prostate (HoLEP) is accepted as safe and efficient, a long learning curve is considered the main reason for its slow adoption in clinical practice. So far, no standardized and easy-to-use parameter has been implemented to measure surgical experience or efficiency which could be useful for training and quality control purposes. The aim of the present study was to evaluate the learning curves of 2 HoLEP beginners and to identify applicable efficiency outcome measures as well as potentially complicating factors in performing HoLEP. Patients and Methods: A total of 594 patients treated by HoLEP between September 2016 and May 2019 were enrolled. The procedures were initially performed by 1 HoLEP expert (reference surgeon); over time, 2 further surgeons were trained. Baseline characteristics, enucleation weight, morcellation and enucleation time, laser energy usage, and postoperative results were recorded prospectively. The learning curves of the 2 novices were analyzed and compared to the reference surgeon. Logistic regression analyses were performed to identify predictors for postoperative grade ≥2 complica

Learning curve and functional outcomes after laser enucleation of the prostate for benign prostate hyperplasia according to surgeon’s caseload

“…This is worrisome as a low complication rate should be the utmost goal for every intervention, especially for a surgery, which is conducted for a benign disease. Rosenhammer et al [25] found that ASA status and prostate cancer were independent predictors for grade ≥ 2 complications but not the caseload, which is consistent with our results, where we also found ASA status and prostate volume, but not caseload, as significant predictor of major complications. Moreover, Westhofen et al [22] found the overall incidence of treatment-related adverse events was significantly higher without a training program.…”

Active Surveillance for Incidental (cT1a/b) Prostate Cancer: Long-Term Outcomes of the Prospective Noninterventional HAROW Study

“…Prostate-specific antigen (PSA) assessment, digital-rectal examination (DRE), and rebiopsies are performed frequently in order to switch to an invasive treatment when signs of progression appear [7,8]. However, due to the low detection rate of 4-9% of prostate cancer after surgical BPO treatment [9][10][11][12][13], data on oncological outcomes of IPC patients are scarce, especially of those managed with AS.…”

Safety and Efficacy of High-Powered Holmium Laser Enucleation of the Prostate within 1–3 Weeks Following Prostate Biopsy

“…It has been shown by imaging methods such as endorectal MRI after a biopsy that alterations in the prostatic tissue can last up to 21 days [15,16] and in some cases up to 4.5 months [17]. Besides, Rosenhammer et al [18] demonstrated that patients with known or expected prostate cancer may be more complex cases with a higher risk for complications. In our study, HoLEP was performed 7-21 days after the biopsy in all patients in group 1.…”