Yüksek Hacimli Prostatlar ile Holep Cerrahisine Başlama: Öğrenme Eğrisi ve Perioperatif Sonuçlar Üzerindeki Etkisi

Abstract

Amaç: Bu çalışma, gerçek yaşam klinik pratiğinde yüksek hacimli prostatlarda Holmium lazer prostat enükleasyonu (HoLEP) uygulamasına başlanmasının öğrenme eğrisi, perioperatif sonuçlar ve kısa dönem fonksiyonel sonuçlar üzerindeki etkilerini kapsamlı olarak değerlendirmeyi amaçladı.
Materyal ve metod: Bu retrospektif çalışmada, Ağustos 2023-Nisan 2025 tarihleri arasında 3 lob tekniği ile HoLEP uygulanan 222 hasta analiz edildi. Hastalar, cerrahi deneyimi yansıtmak ve öğrenme eğrisinin farklı fazları arasında dengeli karşılaştırma yapabilmek amacıyla kronolojik olarak üç eşit gruba ayrıldı. Gruplar; perioperatif sonuçlar, komplikasyonlar ve 3 aylık takipte üriner inkontinans açısından değerlendirildi. Öğrenme eğrisini belirlemek için operasyon süresi, enükleasyon etkinliği ve postoperatif inkontinansa dayalı kümülatif toplam (CUSUM) analizi kullanıldı.
Bulgular: Ortalama prostat hacmi en yüksek grup 1’de saptandı (96,82 ml’ye karşı 83,13 ml ve 71,41 ml, p=0,004). Enükleasyon (p=0,019) ve morcellasyon etkinliği (p=0,008) gruplar arasında anlamlı şekilde artarken, enükleasyon ve morcellasyon süreleri belirgin olarak azaldı (her ikisi için p<0,001). Üç aylık takipte en düşük inkontinans oranı grup 3’te gözlendi (p=0,012). Enükleasyon etkinliği, operasyon süresi ve postoperatif inkontinansa dayalı CUSUM analizi, cerrahın yaklaşık 100 vaka civarında öğrenme fazını tamamladığını ve öğrenme eğrisinin geçiş fazına ulaştığını gösterdi.
Sonuç: Yüksek hacimli prostatlarla HoLEP’e başlanması öğrenme eğrisini literatürde bildirilenin ötesinde uzatabilir; ancak artan deneyimle birlikte cerrahi etkinlik ve fonksiyonel sonuçlar belirgin şekilde iyileşmekte ve HoLEP’in güvenli, etkili ve prostat boyutundan bağımsız bir yöntem olduğu doğrulanmaktadır.

Keywords

• Endoskopik Enükleasyon
• HoLEP
• Holmiyum Lazer
• Öğrenme Eğrisi
• Prostat Hiperplazisi

Initiating Holep for High-Volume Prostates: Impact on Learning Curve and Perioperative Outcomes

Abstract

Background: This study aimed to comprehensively evaluate the learning curve, perioperative outcomes, and short-term functional results associated with initiating Holmium laser enucleation of the prostate (HoLEP)  in patients with high-volume prostates in a real-world clinical setting.
Materials and Methods: In this retrospective study, 222 patients who underwent 3-lobe HoLEP technique between August 2023 and April 2025 were analyzed. Patients were chronologically divided into three equal groups to reflect surgical experience and enable balanced comparison across different phases of the learning curve. The groups were assessed according to perioperative outcomes, complications, and urinary incontinence at a 3-month follow-up. The cumulative sum (CUSUM) chart based on operative time, enucleation efficiency, and postoperative urinary incontinence was utilized to determine the learning curve. 
Results: The mean prostate volume was highest in group 1 (96.82 ml vs. 83.13 ml and 71.41 ml, p=0.004). Enucleation (p=0.019) and morcellation efficiency (p=0.008) significantly improved across groups, while enucleation and morcellation times decreased (both p<0.001). At 3-month follow-up, group 3 demonstrated the lowest rate of incontinence (p=0.012). CUSUM analysis based on enucleation efficiency, operative time, and postoperative incontinence showed that Surgeon had passed the learning phase and was considered around 100 cases, corresponding to the transition phase of the learning curve.
Conclusions: Initiating HoLEP with large prostates may prolong the learning curve beyond commonly reported thresholds; however, increasing experience significantly improves efficiency and functional outcomes, confirming its safety and size-independent efficacy.

Keywords

• Endoscopic Enucleation
• HoLEP
• Holmium Laser
• Learning Curve
• Prostate Hyperplasia

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