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Kosiba M, Hoeh B, Welte MN, Krimphove MJ, Vitucci K, Lindemann N, Schröder J, Jost L, Schmidt FE, von Hollen A, Kluth LA, Mandel P, Roos FC, Chun FKH, Becker A. Learning curve and functional outcomes after laser enucleation of the prostate for benign prostate hyperplasia according to surgeon's caseload. World J Urol 2022; 40:3007-3013. [PMID: 36289106 PMCID: PMC9712403 DOI: 10.1007/s00345-022-04177-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the impact of surgical caseload on safety, efficacy, and functional outcomes of laser enucleation of the prostate (LEP) applying a structured mentoring program. METHODS Patient characteristics, perioperative data, and functional outcomes were analyzed descriptively. Linear and logistic regression models analyzed the effect of caseload on complications, functional outcomes and operative speed. Within the structured mentoring program a senior surgeon was present for the first 24 procedures completely, for partial steps in procedures 25-49, and as needed thereafter. RESULTS A total of 677 patients from our prospective institutional database (2017-2022) were included for analysis. Of these, 84 (12%), 75 (11%), 82 (12%), 106 (16%), and 330 patients (49%) were operated by surgeons at (A) < 25, (B) 25-49, (C) 50-99, (D) 100-199, and (E) ≥ 200 procedures. Preoperative characteristics were balanced (all p > 0.05) except for prostate volume, which increased with caseload. There was no significant difference in change of IPSS, Quality of life, ICIQ, pad usage, peak urine flow, residual urine, and major complications (Group A: 8.3 to E: 7.6%, p = 0.2) depending on the caseload. Caseload was not associated (Odds ratio: 0.7-1.4, p > 0.2) with major complications in the multivariable logistic regression model. Only operating time was significantly shorter with increasing caseload in the multivariable analysis (111-55 min, beta 23.9-62.9, p < 0.001). CONCLUSION With a structured mentoring program, the safety and efficacy of LEP can be ensured even during the learning curve with very good outcome quality. Only the operating time decreases significantly with increasing experience of the surgeon.
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Affiliation(s)
- M. Kosiba
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - B. Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany ,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC Canada
| | - M. N. Welte
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M. J. Krimphove
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - K. Vitucci
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - N. Lindemann
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - J. Schröder
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - L. Jost
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. E. Schmidt
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - A. von Hollen
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - L. A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - P. Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. C. Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - F. K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - A. Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt Am Ain, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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