https://doi.org/10.4081/aiua.2024.12862

Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows

Vol. 96 No. 4 (2024)
Submitted: July 27, 2024
Accepted: September 16, 2024
Published: December 18, 2024
Prostate, minimal invasive, benign prostatic hyperplasia
Abstract Views: 2
PDF: 1
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Authors

Karim Daher
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Moustafa Fathy
https://orcid.org/0009-0008-9210-462X
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada; Urology Department, Menoufia University, Menoufia, Egypt.
Amr Hodhod
Urology Department, King Abdulaziz Medical City, National Guard Hospitals Affairs, Riyadh, Saudi Arabia.
Parsa Nikoufar
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Abdulrahman Alkandari
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Kuwait.
Loay Abbas
https://orcid.org/0000-0001-7514-7005
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario; Urology Department, Theodor Bilharz Research Institute, Giza, Egypt.
Ruba Abdul Hadi
https://orcid.org/0009-0008-0835-1135
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Hazem Elmansy
hazem.mansy@rocketmail.com
Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve. The top-down technique was introduced to lessen the number of procedures required to master HoLEP. We aimed to present the experiences of two successive clinical fellows with the top-down HoLEP learning curve and compare their performance with the supervisor.

Methods: We conducted a prospective study of 40 patients who underwent top-down HoLEP performed by two successive fellows at our institution from September 2020 to November 2022. Before data collection, each learner observed three top-down HoLEP procedures and assisted with seven additional cases before independently performing top-down HoLEP under supervision. We collected data from each fellow’s first 20 consecutive top-down HoLEP procedures. The learners’ cases were grouped according to chronological order (Cases 1-10 and 11-20). The primary outcome was defined as the number of cases before the fellow could independently complete all steps of top-down HoLEP without any major intraoperative complications. The secondary outcomes included the intraoperative and postoperative outcomes of both groups. The fellows’ 40 cumulative cases were then compared against retrospective data from 148 procedures conducted by their supervisor.

Results: There were no significant differences in patient demographics for both clinical fellows. Each learner performed the first 20 cases independently without needing the supervisor to intervene. No major intraoperative complications were recorded, and there were no statistically significant differences in intraoperative and postoperative outcomes between fellows’ cases. There was a statistically significant difference between the fellows and their supervisor in terms of operative efficiency and enucleation efficiency (p < 0.001). We did not find a significant difference between the fellows and the supervisor regarding intraoperative complications, major postoperative complications, or postoperative subjective and objective parameters.

Conclusions: Top-down HoLEP shows promising and reproducible results in shortening HoLEP’s learning curve. Larger comparative and multi-institutional studies are warranted.

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Hazem Elmansy, Urology Department, Thunder Bay Regional Health Sciences Centre, Northern Ontario School of Medicine, Thunder Bay, Ontario

Associate professor, Northern Ontario School of Medicine

How to Cite

Daher, K., Fathy, M., Hodhod, A., Nikoufar , P., Alkandari , A., Abbas, L., Abdul Hadi, R., & Elmansy, H. (2024). Analysis of the top-down HoLEP learning curve: A single-center experience of two clinical fellows. Archivio Italiano Di Urologia E Andrologia, 96(4). https://doi.org/10.4081/aiua.2024.12862
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