Systematic review of the endoscopic enucleation of the prostate learning curve
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ORIGINAL ARTICLE
Systematic review of the endoscopic enucleation of the prostate learning curve Dmitry Enikeev1 · Andrey Morozov1 · Mark Taratkin1 · Vincent Misrai2 · Enrique Rijo3 · Alexei Podoinitsin4 · Svetlana Gabdullina5 · Thomas R. W. Herrmann6,7 Received: 6 April 2020 / Accepted: 7 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning. Evidence acquisition We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve. Evidence synthesis The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30–40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150–200 cases. TUEB required roughly 40–50 cases to reach the plateau. Conclusion Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30–50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning. Keywords Systematic review · BPH · Prostate enucleation · Learning curve · Endoscopic enucleation · Laser enucleation Abbreviations EEP Endoscopic enucleation of the prostate TURP Transurethral resection of the prostate * Dmitry Enikeev [email protected] 1
RPE Radical prostatectomy TUEB Transurethral enucleation with bipolar HoLEP Holmium laser prostate enucleation ThuLEP Thulium-YAG prostate enucleation ThuFLEP Thulium fiber laser prostate enucleation MEP Monopolar prostate enucleation PRISMA Preferred reporting items of systematic reviews and meta-analyses WoS Web of Science PSA Prostate specific antigen BPH Benign prostatic hyperplasia
Institute for Urology and Reproductive Health, Sechenov University, 2/1, Bolshaya Pirogovskaya str, Moscow 119991, Russia
2
Department of Urology, Clinique Pasteur, Toulouse, France
3
Department of Urology, Hospital Quirón Salud, Barcelona, Spain
4
Moscow Regional Research and Clinical Institute Moniki N.a. M.F. Vladimirskiy, Moscow, Russia
Introduction
5
Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
6
Department of Urology, Spital Thurgau AG, Pfaffenholzstra
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