Presented by: Sven Piesche Dr. med.
Sana Klinikum Hof, Germany

Introduction

Holmium Laser Enucleation of the Prostate with Enhanced Pulse Setting (HoLEP-EPS) uses a high pulse energy to optimize the benefit of the mechanical dissecting effect of the Holmium laser pulse. As this crucially supports the surgeon to find and dissect the capsular layer, the EPS might be beneficial for beginners.

We prospectively evaluated the learning curve of HoLEP-EPS.

Materials

Using 6 standardized teaching steps and a mentored training, the learning curves of 5 HoLEP-beginners (Hof, Germany and Ede, The Netherlands) were created. Primary endpoint was the number of operations necessary to master the complete operation (enucleation as well as morcellation) without the teacher (Fig. 1)

For all enucleationes the Enhanced Pulse Setting (EPS) (4J / 35 Hz or 3J / 37 Hz) was used. Laser machines, morcellators, resectoscopes as well as surgeons endourological experience varied.

Results

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The median number of operations needed to master a HoLEP-EPS was 9 (Range 5-15) (Fig. 2)

Average operation speed during the learning curve 0.69 g/min

Median catheter time 24 h

Rate of transient incontinence 18%.

Complication rate (Clavien-Dindo-scale) II-III 6%, IV-V none.

Conclusion

HoLEP EPS with a standardized mentor based training provides a fast learning success as well as a low complication rate. Therefore, the EPS-setting might be advantageous especially for beginners. However, comparative studies with other pulse settings are necessary to confirm the results.

Funding

None

Lead Authors

Razvan Dican, Dr.
Sana Klinikum Hof

Co-Authors

Horia Radu, Dr.
Sana Klinikum Hof

Michael Kortleve,
Ziekenhuis Gelderse Vallei Afdeling Urologie