Holmium laser enucleation of the prostate: Learning curve analysis and comparison with TURP

Benign prostatic obstruction (BPO) is a prevalent cause of lower urinary tract symptoms (LUTS), traditionally managed with transurethral resection of the prostate (TURP). However, advances in technology, particularly holmium laser enucleation of the prostate (HoLEP), offer an alternative approach. Our aim was to compare the outcomes of HoLEP, during both the surgeon's learning and expert phases, to TURP, assessing perioperative safety, efficacy, and functional recovery.

This prospective study included 200 men with BPO-related LUTS, divided into three groups: group 1: TURP (n = 100), group 2: HoLEP during the learning curve (n = 50), and group 3: post-learning curve (n = 50). Outcomes analyzed included learning curve analysis, IPSS, QoL, Q_max, PVR, surgical efficiency, and complication rates. Postoperative outcomes were assessed at 1 and 6 months.

The HoLEP learning curve reached a plateau around case 30, and improved after case 50. Group 3 demonstrated significantly better outcomes in surgical efficiency and functional recovery compared to groups 1 and 2. Enucleation efficiency in group 3 was higher, and the operative time was shorter. Postoperatively, the Q_max, IPSS and PVR improved significantly across all groups but were highest in group 3, followed by group 2 and group 1. Regarding safety, group 3 had the lowest complication rates, with significantly less frequent postoperative bleeding. Catheter removal time was slightly shorter in group 2 compared to both groups 1 and 3.

HoLEP, especially after overcoming the learning curve, provides better perioperative safety, greater efficiency, and improved functional outcomes compared to TURP, making it a highly effective treatment.