The learning curve of thulium laser enucleation of the prostate: a single-centre experience

Abstract

OBJECTIVES: To estimate the learning curve for thulium laser enucleation of the prostate (ThuLEP) performed by the same surgeon, appreciating the sequential progression in skill and proficiency over time. PATIENTS AND METHODS: The study retrospectively enrolled 60 patients with benign prostatic hyperplasia (BPH) who underwent the ThuLEP procedure performed by a single experienced endourologist. Though not initially skilled with laser enucleation of the prostate, the surgeon had observed numerous cases before. The patients were divided into three groups, each containing 20 cases. The procedure started with inspection, followed by incision and trough creation and plane development, apicolateral dissection, sphincter release, anterior dissection, bladder neck dissection, C-shaped baso-lateral dissection, and adenoma detachment technique called veil-sparing ThuLEP using the ABCD method. Perioperative parameters, enucleation and morcellation time (min), enucleation efficiency (g/min), morcellation efficiency (g/min), enucleated tissue weight (g), hospital stay time, and catheterization time (h) were recorded. RESULTS: There was a statistically significant decrease in the International Prostate Symptom Score (IPSS) 6 months postoperatively (median = 3) compared with 1-day postoperatively (median = 4) and preoperatively (median = 25). Uroflowmetry parameters, IIEF-5 scores, enucleation and morcellation efficiency, hospitalization period, and catheterization time were evaluated, showing substantial improvements and stabilization over time. CONCLUSIONS: A highly skilled endourologist in TURP was able to master the learning curve of ThuLEP after completing the initial 40 patients. Upgrading the sequential progression in skill and proficiency over time for treating benign prostatic hyperplasia in addition to its safety, feasibility, efficacy that improve procedure outcome with fewer difficulties.