Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers

To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP.

Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients' characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups.

Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Q max at 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP.

Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.

World journal of urology. 2016 Oct 20 [Epub ahead of print]

Benoit Peyronnet, Grégoire Robert, Vincent Comat, Morgan Rouprêt, Fernando Gomez-Sancha, Jean-Nicolas Cornu, Vincent Misrai

Department of Urology, Rennes University Hospital, Rennes, France., Department of Urology, Bordeaux Hospital, Université de Bordeaux, Bordeaux, France., AP-HP, Hospital Pitié-Salpétrière, Service d'Urologie, 75013, Paris, France., CUA - Clínica CEMTRO, Madrid, Spain., Department of Urology, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France., Department of Urology, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France. .