Enucleation ratio efficacy might be a better predictor to assess learning curve of holmium laser enucleation of the prostate

purpose: to appraise the evaluation methods for learning curve and to analyze the non-mentor-aided learning curve and early complications following the holmium laser enucleation of the prostate. materials and methods:one-hundred and forty (n=140) consecutive patients who underwent holep from july 2008 to july 2010 by a single surgeon (sjo) were enrolled. perioperative clinical variables, including enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), enucleation efficacy (enucleated weight/enucleation time), enucleation ratio efficacy (enucleation ratio/enucleation time), and early complication rate were analyzed. results: mean prostate volume was 62.7 ml (range 21-162) and preoperative international prostate symptom score (ipss) was 19.0 (4-35). mean enucleation time and morcellation time were 49.9±23.8 (s.d.) min and 11.0±9.7 min, respectively. median duration of postoperative indwelling catheter was 1 (1-7) day and median hospital stay was 1 (1-6) day. there were a total of 31 surgery-related complications in 27 patients (19.3%), and all were manageable. there was an increasing trend of enucleation efficacy in the first 50 cases. however, enucleation efficacy was linearly correlated with the prostate size (correlation coefficients, r=0.701, p<0.001). but, enucleation ratio efficacy could eliminate the confounding effect of the prostate size (r=-0.101, p=0.233). the plateau of enucleation ratio efficacy was reached around the twenty-fifth case. conclusions: our results demonstrated that the operative learning curve plateau is reached after about 25 cases. we propose that a more appropriate parameter for estimating the operative learning curve is enucleation ratio efficacy, rather than enucleation efficacy.