Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy.
Residency Program in Health Statistics and Biometrics, University of Verona, Verona, Italy.
J Endourol. 2024 Nov;38(11):1226-1233. doi: 10.1089/end.2024.0422. Epub 2024 Aug 28.
To report the surgical and functional outcomes of the holmium laser enucleation of the prostate (HoLEP) surgical program implemented at a high-volume tertiary referral center and to estimate the learning curve (LC) duration for this surgical procedure. Data of all consecutive patients undergoing HoLEP at the University of Verona between June 2022 and April 2024 were retrieved from a prospectively maintained institutional database of patients undergoing benign prostatic hyperplasia (BPH) surgical treatment. The primary endpoint was functional outcomes evaluation during the surgeons' LC. The secondary endpoint was to define the surgical LC for HoLEP. A multivariable test of means was performed to compare functional outcomes at different time points. After adjusting for potential confounders (age, preoperative pharmacotherapy, and prostate volume), multivariable linear regression models were fitted to evaluate the effect of experience on operative time (OT) and enucleation efficiency. To assess LCs for HoLEP surgery, the non-risk-adjusted cumulative sum (CUSUM) method was used. A statistically significant improvement in International Prostate Symptoms Score (IPSS) score, delta% IPSS score, IPSS quality of life (IPSS-QoL) score, and delta% IPSS-QoL score was observed over the study period. Furthermore, the incidence of irritative symptoms ( < 0.001) and stress incontinence ( = 0.01) significantly decreased over time, with a 12-month incidence of 8.4% and 9.5%, respectively. A statistically significant association between experience and both OT and enucleation efficiency was observed in multivariable linear regression analysis. The CUSUM chart for OT and enucleation efficiency showed a steep initial upward/downward trend of ∼50 cases each, and a plateau until ∼100 procedures are reached, where the breakpoint is recognized for both variables and where the CUSUM curve goes below the locally weighted scatterplot smoothing curve in the corresponding observed-expected CUSUM plot. HoLEP represents an effective treatment for BPH, demonstrating significant improvement in BPH-related symptoms over the study period, despite the considerable LC of ∼50 cases associated with the procedure.
报告在高容量三级转诊中心实施的钬激光前列腺剜除术（HoLEP）手术计划的手术和功能结果，并估计该手术程序的学习曲线（LC）持续时间。从维罗纳大学良性前列腺增生（BPH）手术治疗患者的前瞻性维护机构数据库中检索了 2022 年 6 月至 2024 年 4 月期间接受 HoLEP 的所有连续患者的数据。主要终点是在外科医生的 LC 期间进行功能结果评估。次要终点是确定 HoLEP 的手术 LC。使用均值的多变量检验比较不同时间点的功能结果。在调整了潜在混杂因素（年龄、术前药物治疗和前列腺体积）后，拟合多变量线性回归模型以评估经验对手术时间（OT）和剜除效率的影响。为了评估 HoLEP 手术的 LC，使用非风险调整累积和（CUSUM）方法。在研究期间，国际前列腺症状评分（IPSS）评分、delta% IPSS 评分、IPSS 生活质量（IPSS-QoL）评分和 delta% IPSS-QoL 评分均显著改善。此外，刺激性症状的发生率（<0.001）和压力性尿失禁（=0.01）随着时间的推移显著降低，分别为 12 个月时的 8.4%和 9.5%。多变量线性回归分析显示，经验与 OT 和剜除效率之间存在统计学显著关联。OT 和剜除效率的 CUSUM 图表显示，每个变量的初始陡峭上升/下降趋势约为 50 例，直到达到约 100 例时达到平台，此时两个变量的断点被识别，并且 CUSUM 曲线在相应的观察到的预期 CUSUM 图中的局部加权散点图平滑曲线下方。HoLEP 是 BPH 的有效治疗方法，尽管该手术的 LC 约为 50 例，但在研究期间，BPH 相关症状显著改善。
