Holmium laser enucleation of the prostate: the safety, efficacy, and learning experience in China

PURPOSE: Holmium laser enucleation of the prostate (HoLEP) is a well established procedure for the treatment of benign prostatic hyperplasia. Here we report our experience of the learning curve, efficacy, and safety of HoLEP. METHODS: We retrospectively reviewed data from 190 consecutive patients who had undergone HoLEP for benign prostatic hyperplasia. The patients were divided into three groups: group 1--patients 1 to 50; group 2--patients 51 to 100; and group 3--patients 101 to 190. This analysis included our initial experience with the technique reflecting our learning curve. All patients were assessed preoperatively and 12 months postoperatively. Patient baseline characteristics, perioperative data, and postoperative outcome were compared in the three groups. All complications were noted. RESULTS: HoLEP resulted in a significant improvement in voiding symptoms and urodynamic parameters. The improvements in peak urinary flow rate, post-void residual urine, International Prostate Symptom Score, and quality-of-life index did not change significantly as experience increased. However, the operative time decreased significantly as experience increased. The surgeon became more confident with the HoLEP technique after about 15 cases in those with moderate-sized prostates. The postoperative rates for complications such as bladder mucosal injury, recatheterization and transient urinary incontinence were higher in group 1 than in the other two groups. CONCLUSIONS: Holmium laser enucleation of the prostate is a safe and effective treatment option for benign prostatic hyperplasia, even when performed by inexperienced surgeons. The incidence of complications decreases with increasing experience with the procedure.