Prospective Assessment of Learning Curve of Holmium Laser Enucleation of the Prostate for Treatment of Benign Prostatic Hyperplasia Using a Multidimensional Approach
| Autor: | Ramy Mekkawy, Mahmoud Laymon, Ahmed R. El-Nahas, Ahmed El-Assmy, Hossam Nabeeh, Yasser Eldemerdash, Ahmed M. Elshal |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Urology Enucleation Prostatic Hyperplasia 030232 urology & nephrology Holmium laser Urinary incontinence Lasers Solid-State 03 medical and health sciences 0302 clinical medicine Prostate medicine Humans Prospective Studies Aged Prostatectomy business.industry Outcome measures Perioperative Hyperplasia medicine.disease Surgery Prostate-specific antigen medicine.anatomical_structure 030220 oncology & carcinogenesis Laser Therapy medicine.symptom business Learning Curve |
| Zdroj: | Journal of Urology. 197:1099-1107 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/j.juro.2016.11.001 |
| Popis: | Despite being endorsed in most guidelines, wide adoption of holmium laser enucleation of the prostate is hindered by learning difficulties. We prospectively assessed the learning curve using a multidimensional approach.We prospectively report all perioperative safety and efficacy outcome measures as well as the need for reoperation and continence status. Case difficulty and learning curve characterization variables were considered, looking for predictors of different outcome measures. Our analysis included the first 313 procedures done by a total of 3 surgeons.Prostate volume and the number of previously performed cases independently predicted operative and enucleation efficiency (mean ± SD 0.76 ± 0.36 and 1.2 ± 0.6 gm per minute, respectively). Both measures plateaued only after the first 40 procedures. The mean percent reduction in postoperative prostate specific antigen was 80% ± 19%. A significantly lower decrease was independently predicted by the transrectal ultrasound depiction of a grossly multinodular prostate (p = 0.000, RPlateauing through the learning curve of holmium laser enucleation of the prostate is a moving target. Looking at different outcome measures, different levels of experience are needed to reach the plateau. Preoperative prostate volume, the number of previously performed cases and case density are the main influential factors in the curve. Urinary incontinence is the most relevant clinical outcome that was significantly affected by learning, although its transient nature is assuring. |
| Databáze: | OpenAIRE |
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