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

Abstract

Purpose To evaluate the impact of surgical caseload on safety, efficacy, and functional outcomes of laser enucleation of the prostate (LEP) applying a structured mentoring program. Methods Patient characteristics, perioperative data, and functional outcomes were analyzed descriptively. Linear and logistic regression models analyzed the effect of caseload on complications, functional outcomes and operative speed. Within the structured mentoring program a senior surgeon was present for the first 24 procedures completely, for partial steps in procedures 25–49, and as needed thereafter. Results A total of 677 patients from our prospective institutional database (2017–2022) were included for analysis. Of these, 84 (12%), 75 (11%), 82 (12%), 106 (16%), and 330 patients (49%) were operated by surgeons at (A) < 25, (B) 25–49, (C) 50–99, (D) 100–199, and (E) ≥ 200 procedures. Preoperative characteristics were balanced (all p > 0.05) except for prostate volume, which increased with caseload. There was no significant difference in change of IPSS, Quality of life, ICIQ, pad usage, peak urine flow, residual urine, and major complications (Group A: 8.3 to E: 7.6%, p = 0.2) depending on the caseload. Caseload was not associated (Odds ratio: 0.7–1.4, p > 0.2) with major complications in the multivariable logistic regression model. Only operating time was significantly shorter with increasing caseload in the multivariable analysis (111–55 min, beta 23.9–62.9, p < 0.001). Conclusion With a structured mentoring program, the safety and efficacy of LEP can be ensured even during the learning curve with very good outcome quality. Only the operating time decreases significantly with increasing experience of the surgeon.

Age‐specific effect of transurethral holmium laser enucleation of the prostate on overactive bladder in men with benign prostatic hyperplasia: An investigation using an overactive bladder symptom score

“…Keeping these mechanisms in mind, it is conceivable that older patients suffer from the longer duration of BOO as well as age‐related changes, which resulted in the poorer improvement of OAB in patients aged ≥75 years than in the other groups. Moreover, there was no significant difference in the resolution rate of OAB and de novo OAB rate by caseload, which is consistent with the findings that caseload was not related to improvement in LUTS as well as LUTF 27,28 …”

“…Moreover, there was no significant difference in the resolution rate of OAB and de novo OAB rate by caseload, which is consistent with the findings that caseload was not related to improvement in LUTS as well as LUTF. 27,28…”

The learning curve for transurethral enucleation with bipolar energy for benign prostate hyperplasia: a single-surgeon experience of 494 patients

“…Moreover, we had no prostate size-based training curriculum for TUEB as described in previous research. 25 Because the present study was based on the experience of a single operator, the ability to generalize our results may be limited. Therefore, further prospective studies based on multiple operators should be performed.…”

Thulium fiber laser vs. holmium laser enucleation of the prostate: results of a prospective randomized non-inferiority trial

“…Although the TFL was a relatively new laser source for our surgeons, who were all used to the holmium laser, our reported ThuFLEP enucleation efficiency of 1.45g/min is still higher than achieved in other publications (1.04 to 1.40g/min) [ 8 , 10 , 13 , 17 , 19 , 20 , 28 ]. This suggests that ThuFLEP has already been performed efficient and concerns about the learning curve can be put into perspective [ 12 , 29 ].…”