Katsumi Shigemura1, Fukashi Yamamichi2, Koichi Kitagawa3, Masuo Yamashita4, Yasuhiko Oka5, Hirokazu Tanaka6, Masato Fujisawa7. 1. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Infectious Disease, Department of Health Science, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: katsumi@med.kobe-u.ac.jp. 2. Department of Urology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 3. Division of Translational Research for Biologics, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan. 4. Department of Urology, Shinko Memorial Hospital, Kobe, Japan. 5. Department of Urology, Kakogawa Central Municipal Hospital, Kakogawa, Japan. 6. Department of Urology, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan. 7. Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
Abstract
PURPOSE: Holmium laser enucleation of the prostate has become an increasingly common surgical therapy for benign prostatic hyperplasia. However, the relationship between surgeon experience and surgical outcomes has not yet been fully investigated. In this study we investigated how surgeon experience with holmium laser enucleation of the prostate affected operative time, adverse events and outcomes related to urination. MATERIALS AND METHODS: We gathered a total of 1,113 cases of holmium laser enucleation of the prostate from 5 hospitals in Hyogo Prefecture, Japan. Included were data on surgeon experience with the procedure, operative time, enucleation time, morcellation time, patient age, perioperative and postoperative surgery related complications, and outcomes related to urination. RESULTS: A total of 39 surgeons were included in analysis. Statistical data showed that increasing surgical experience significantly contributed only to surgical time, enucleation time and urinary incontinence after holmium laser enucleation (p = 0.0146, 0.0216 and 0.0405, respectively). No significant changes were seen postoperatively in surgery related factors such as morcellation time, resected prostate volume, infectious or noninfectious surgery related complications, or urination related outcomes (p >0.05) Experience with at least 20 cases in particular affected surgical time (p = 0.0050), enucleation time (p = 0.0068) and urinary incontinence after holmium laser enucleation (p = 0.0021). CONCLUSIONS: Surgeon experience contributed to shortened operative time and enucleation time, and to decreased postoperative urinary incontinence but not to surgery related complications or urination related outcomes as shown by maximum urine flow and post-void residual urine volume. We also found that experienced surgeons with 31 to 50 cases might be associated with complications after holmium laser enucleation in larger prostate cases. Based on these data further prospective studies are scheduled to establish a program for training in holmium laser enucleation of the prostate.
PURPOSE:Holmium laser enucleation of the prostate has become an increasingly common surgical therapy for benign prostatic hyperplasia. However, the relationship between surgeon experience and surgical outcomes has not yet been fully investigated. In this study we investigated how surgeon experience with holmium laser enucleation of the prostate affected operative time, adverse events and outcomes related to urination. MATERIALS AND METHODS: We gathered a total of 1,113 cases of holmium laser enucleation of the prostate from 5 hospitals in Hyogo Prefecture, Japan. Included were data on surgeon experience with the procedure, operative time, enucleation time, morcellation time, patient age, perioperative and postoperative surgery related complications, and outcomes related to urination. RESULTS: A total of 39 surgeons were included in analysis. Statistical data showed that increasing surgical experience significantly contributed only to surgical time, enucleation time and urinary incontinence after holmium laser enucleation (p = 0.0146, 0.0216 and 0.0405, respectively). No significant changes were seen postoperatively in surgery related factors such as morcellation time, resected prostate volume, infectious or noninfectious surgery related complications, or urination related outcomes (p >0.05) Experience with at least 20 cases in particular affected surgical time (p = 0.0050), enucleation time (p = 0.0068) and urinary incontinence after holmium laser enucleation (p = 0.0021). CONCLUSIONS: Surgeon experience contributed to shortened operative time and enucleation time, and to decreased postoperative urinary incontinence but not to surgery related complications or urination related outcomes as shown by maximum urine flow and post-void residual urine volume. We also found that experienced surgeons with 31 to 50 cases might be associated with complications after holmium laser enucleation in larger prostate cases. Based on these data further prospective studies are scheduled to establish a program for training in holmium laser enucleation of the prostate.
Authors: Dmitry Enikeev; Andrey Morozov; Mark Taratkin; Vincent Misrai; Enrique Rijo; Alexei Podoinitsin; Svetlana Gabdullina; Thomas R W Herrmann Journal: World J Urol Date: 2020-09-17 Impact factor: 4.226
Authors: Bernd Rosenhammer; Maximilian Schönhärl; Roman Mayr; Marco J Schnabel; Maximilian Burger; Christian Eichelberg Journal: Urol Int Date: 2020-09-02 Impact factor: 2.089
Authors: Onur Acikgoz; Mehmet Yilmaz; Halil Cagri Aybal; Sercan Yilmaz; Eymen Gazel; Serdar Yalcin; Mehmet Duvarci; Engin Kaya; Arkadiusz Miernik; Lutfi Tunc Journal: Cent European J Urol Date: 2021-10-22