Does Surgeon Experience Affect Operative Time, Adverse Events and Continence Outcomes in Holmium Laser Enucleation of the Prostate? A Review of More Than 1,000 Cases

• Published in: The Journal of urology Vol. 198; no. 3; pp. 663 - 670
• Main Authors: Shigemura, Katsumi, Yamamichi, Fukashi, Kitagawa, Koichi, Yamashita, Masuo, Oka, Yasuhiko, Tanaka, Hirokazu, Fujisawa, Masato
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: lasers; learning curve; prostatic hyperplasia; surgeons; transurethral resection of prostate; Urology; urodynamic study; post-void residual urine volume; surgeons; UDS; maximum urine flow; holmium laser enucleation of prostate; urinary incontinence; benign prostate hyperplasia; lasers; RUV; transurethral resection of prostate; UI; Qmax; TURP; HoLEP; BPH; transurethral prostate resection; prostatic hyperplasia; learning curve
• ISSN: 0022-5347; 1527-3792
• DOI: 10.1016/j.juro.2017.04.087

Purpose Holmium laser enucleation of the prostate has become an increasingly common surgical therapy for benign prostate hyperplasia. However, the relationship between surgeon experience and surgical outcomes has not yet been fully investigated. In this study we investigated how surgeon experience with holmium laser enucleation of the prostate affected operative time, adverse events and outcomes related to urination. Materials and Methods We gathered a total of 1,113 cases of holmium laser enucleation of the prostate from 5 hospitals in Hyogo Prefecture, Japan. Included were data on surgeon experience with the procedure, operative time, enucleation time, morcellation time, patient age, perioperative and postoperative surgery related complications, and outcomes related to urination. Results A total of 39 surgeons were included in analysis. Statistical data showed that increasing surgical experience significantly contributed only to surgical time, enucleation time and urinary incontinence after holmium laser enucleation (p = 0.0146, 0.0216 and 0.0405, respectively). No significant changes were seen postoperatively in surgery related factors such as morcellation time, resected prostate volume, infectious or noninfectious surgery related complications, or urination related outcomes (p >0.05) Experience with at least 20 cases in particular affected surgical time (p = 0.0050), enucleation time (p = 0.0068) and urinary incontinence after holmium laser enucleation (p = 0.0021). Conclusions Surgeon experience contributed to shortened operative time and enucleation time, and to decreased postoperative urinary incontinence but not to surgery related complications or urination related outcomes as shown by maximum urine flow and post-void residual urine volume. We also found that experienced surgeons with 31 to 50 cases might be associated with complications after holmium laser enucleation in larger prostate cases. Based on these data further prospective studies are scheduled to establish a program for training in holmium laser enucleation of the prostate.