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Updated: Jul 9, 2026
Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
Prospective analysis of the learning curve in holmium laser enucleation of the prostate (HoLEP): A 125 case series
L E Ortega Polledo1, E García Rico2, A Sánchez Pellejero3
1Instituto de Urología de la Peña-Hidalgo-Alonso, Madrid, Spain; Hospital Clínico San Carlos, Servicio de Urología, Madrid, Spain.
Objective:
The objective is to evaluate the effectiveness and safety of a surgeon's learning curve for holmium laser enucleation of the prostate (HoLEP) in 125 consecutive cases.
Materials And Methods:
Preoperative baseline characteristics, functional outcomes, surgical times, and complications of the first 125 patients treated by HoLEP were recorded. The sample was divided into quintiles (25 cases/group), and statistical analysis was carried out using the ANOVA test, Kruskal-Wallis H test, Chi-squared test, and likelihood-ratio test.
Results:
Surgical time decreased progressively: 92 min. (Q1), 65 min. (Q2), 54 min. (Q3), 45 min. (Q4) and 50 min. (Q5) (p < 0.001). Enucleation rate gradually increased: 1.08 g/min (Q1), 1.65 g/min (Q2), 1.82 g/min (Q3), 1.96 g/min (Q4) and 2.74 g/min (Q5) (p < 0.001). There were no differences in enucleated weight (Q1: 51 g, Q2: 57 g, Q3: 51 g, Q4: 53 g, Q5: 65 g) (p = 0.21), length of hospital stay (median 1.12 days), bladder catheterization (mean 1.51 days), intra- and postoperative complications or urethral stricture (5.6%) (p > 0.05). Time to continence recovery was similar in quintiles 1-4 (23, 27, 21, 20 days) and shorter in quintile 5 (3.5 days) (p < 0.001).
Conclusion:
The initiation of a HoLEP program following the completion of training demonstrates a low morbidity rate and highly favorable functional outcomes. The efficiency of the technique demonstrates a linear and consistent increase from the outset of the learning curve, with significantly reduced surgical times achieved after 25 cases.
