Evolution and success of holmium laser enucleation of the prostate

Switching lasers: learning curve of HoLEP in surgeons experienced in ThuLEP

OBJECTIVE

To evaluate perioperative parameters, clinical outcomes, and the learning curve of holmium laser enucleation of the prostate (HoLEP) in surgeons with experience in thulium laser enucleation of the prostate (ThuLEP).

MATERIALS AND METHODS

The learning curves for HoLEP of the first 50 consecutive patients of two surgeons experienced in ThuLEP were analyzed. In addition, demographic parameters, clini¬cal outcomes and adverse events were evaluated.

RESULTS

Mean operation time was 70.9 + 29.7 min (SD) (Surgeon 1) and 74.4 + 35.4 min (Surgeon 2), the mean enucleation efficiency was 1.5 + 0.6 g/min (Surgeon 1) and 1.5 + 0.7 g/min (Surgeon 2). The hemoglobin loss was 0.9 + 0.8 g/dl and 0.8 + 0.8 g/dl. For both surgeons, there was a significant learning curve in enucleation efficiency within the first 50 cases (Surgeon 1: p = .034, Surgeon 2: p = .006, both: p = .0003, Spearman's ρ = .351). Both surgeons started with an enucleation efficiency of around 1g/min in their first 10 cases. No significant correlation between hemoglobin loss and experience could be found (p = .823, ρ = .025). While there was no significant learning curve for morcellation efficiency (p = .785, ρ = .028), a significant progress was found for one of the two surgeons regarding laser energy efficiency (p = .014). The overall incidence of all grade treatment-related adverse events was very low at 10.0%, and extremely low for significant complications with Clavien-Dindo Grade > II at 1%.

CONCLUSIONS

In our analysis, switching to HoLEP is uncomplicated and safe for experienced ThuLEP surgeons. The enucleation efficiency was high from the beginning, but a learning curve was present for both surgeons. No learning curve was noticeable in hemoglobin loss and the incidence of complications, both of which were very low throughout the study.

The Evolution of Endoscopic Prostate Enucleation: A historical perspective

Here, we review the evolution of prostate enucleation in chronological order based on energy technology starting first with holmium laser, then bipolar electrocautery, followed by thulium laser and finally greenlight and diode laser enucleation of the prostate.

The industrial revolution for the management of benign prostate obstruction: worldwide publication trends for surgical and medical therapies over the past two decades

INTRODUCTION

Research for management of benign prostate obstruction (BPO) for adult males remains a cornerstone of urology research. This landscape has witnessed the rise and fall of multiple therapies, both surgical and medical. Our aim was to formally evaluate the publication trends for these interventions over the past 20 years.

MATERIAL AND METHODS

A systematic search was performed in a Cochrane style. Data was analysed using the independent t-test and Pearson's correlation coefficient (SPSS version 24). To observe changes in trends more effectively, data was sub-divided into two time periods: 1997 to 2006 and 2007 to 2016.

RESULTS

Over the past 20 years, 4236 papers have been published concerning for BPO (surgical, n = 2177 and medical, n = 2059). For surgical treatments, these included articles on monopolar transurethral resection of prostate (TURP) (n = 340), bipolar TURP (n = 260), HoLEP (n = 293) and Greenlight laser (n = 395). For medical therapies, these included alpha blockers (848), 5-alpha reductase inhibitors (n = 618) and PDE5I (n = 91). Between the two time periods the change was +18.8% (p = 0.108) for monopolar TURP, +497.1% (<0.001) for bipolar TURP, -54.5% (p <0.001 for prostatic stents and -81.9% (p <0.001) for transurethral microwave therapy (TUMT). There was over 290% rise in number of publications related to BPO laser surgery (p <0.001). For medical interventions, the change was +11.5% (p = 0.397) for alpha blockers, -1.9% (p = 0.867), +49.0%( 0.122) for phytotherapy, +2075% (p <0.001) for PDEI and +2375.0% (p <0.001) for combined alpha blocker and anti-muscarinics.

CONCLUSIONS

Interventions for BPO have undergone a high volume of research. In particular, minimally invasive laser surgeries and combined medical therapies have seen significant expansion.