Holmium Laser Enucleation for Prostatic Adenoma: Analysis of Learning Curve Over the Course of 70 Consecutive Cases

PURPOSE: We elucidate the learning curve, efficacy and safety of holmium laser enucleation of prostatic adenomas. MATERIALS AND METHODS: We retrospectively reviewed data on 70 patients who had undergone holmium laser enucleation for prostatic adenoma. All patients were assessed preoperatively and at an interval of 6 months postoperatively based on the International Prostate Symptom Score, quality of life index, peak urinary flow rate and post-void residual urine measurement. All complications were noted. The relationship between the number of procedures performed and treatment efficacy was analyzed. The learning curve with regard to efficiency for tissue enucleation and morcellation was assessed. RESULTS: Holmium laser enucleation of the prostate resulted in a significant improvement in subjective symptoms and urodynamic parameters. The ratio of improvement in the preoperative-to-postoperative 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 efficiency of enucleation increased significantly as experience increased. Complications included short-term stress urinary incontinence in 8 cases and postoperative urethral stricture in 5. Bladder injury during morcellation was observed in 2 cases. CONCLUSIONS: Holmium laser enucleation of the prostate is an effective treatment option for benign prostatic adenoma, providing good treatment efficacy and minimal bleeding even if the surgeon has minimal experience. It requires more time to perform than traditional surgery but there is a learning curve for the enucleation technique as experience increases. Technical improvement in tissue morcellation may be necessary if the prevalence of this treatment is to increase dramatically.