Presentation Authors: Katsumi Shigemura*, Koji Chiba, Keisuke Okada, Masato Fujisawa, Kobe, Japan
Introduction: The surgical treatments for benign prostate hyperplasia (BPH) has been changed and holmium laser enucleation of the prostate (HoLEP) has become to play larger role on it than before. HoLEP research tends to focus on the surgical outcomes but that of surgery education is not fully investigated. In this study, for the purpose of establishing the surgeon educational system of HoLEP, the data from 5 hospitals were investigated in order to find the answer for 1) how many cases do they need for reaching plateau of surgical time? 2) what should we do for prevention of adverse events?
Methods: This is a multi-center retrospective study from a total of 1113 cases of HoLEP with full data for analysis as to surgery, preoperative prostate volume, postoperative urination-related factors such as maximal flow rate and residual urine volume and surgery related complication. Surgical procedure and the instrumentation of HoLEP are the same. Complications were categorized as intra-operative, postoperative short-term and long-term ones. The surgeons with less than 20 cases were supervised during HoLEP.
Results: Total 1113 cases were done by 39 surgeons in 5 hospitals in these 10 years with median 24 cases experience. The statistical results showed HoLEP experience positively contributed only to surgical time, enucleation time and reducing postoperative urinary incontinence (p=0.0146, 0.0216 and 0.0405, respectively) even though patients&[prime] backgrounds are similar. These results are emphasized in 20 cases or more of experiences. However, more number of HoLEP experience did not contribute to morcellation time, resected prostate volume, infectious or noninfectious surgery related complications, or urination related outcomes (p>0.05). Moreover, moderately experienced surgeons (31-50 cases) had higher post-HoLEP complications in larger prostate cases, suggesting the possibility that experience may make the surgeons lose caution in a way.
Conclusions: Our data showed 20 cases experience positively contributed to shortened operative time and enucleation time and reducing postoperative urinary incontinence but not to surgery related complications or urination related outcomes as shown by maximum flow rate and post-void residual urine volume. We also found that moderately experienced surgeons had more complications in larger prostate cases. Based on them, we suggest as follows: 1) 20 cases are necessary for learning curve. 2) Reducing complications are always necessary to be paid attention. 3) Moderate experience might lose attention so we should not forget what we think in the initial case.