Efficacy and learning curve of three-lobe holmium laser enucleation of the prostate for benign prostatic hyperplasia in county-level hospitals
10.12483/j.issn.1009-8291.2026.03.010
- VernacularTitle:县级医院开展三叶法钬激光剜除术治疗良性前列腺增生的疗效分析及术者学习曲线研究
- Author:
Yongsheng PAN
1
;
Bo LIU
2
;
Jie JIANG
1
;
Xinchao XIA
2
;
Qianjin WANG
2
;
Asihati REWULI
2
;
Tianle WANG
3
;
Hua ZHU
1
;
Wei XUE
4
;
Bing ZHENG
1
Author Information
1. Department of Urology, Nantong First People's Hospital, Nantong 226001; Nantong University Institute of Urological Diseases, Nantong 226001
2. Department of Urology, Yining County People's Hospital, Yili Kazak Autonomous Prefecture 844500
3. Department of Radiology, Nantong First People's Hospital, Nantong 226001
4. Department of Urology, Nantong First People's Hospital, Nantong 226001; Nantong University Institute of Urological Diseases, Nantong 226001; Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
- Publication Type:Journal Article
- Keywords:
benign prostatic hyperplasia;
holmium laser enucleation;
three-lobe technique;
learning curve;
countylevel hospital
- From:
Journal of Modern Urology
2026;31(3):258-263
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.
