Evaluation of the learning curve for photoselective vaporization of the prostate over the course of 74 cases.
OBJECTIVE
To evaluate the learning experience, in addition to its impact on outcomes, in patients with benign prostatic hyperplasia (BPH) who undergo photoselective vaporization of the prostate (PVP).


METHODS
The study included 74 Japanese patients who underwent PVP. All patients were assessed for treatment efficacy in outcome variables including the International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, peak urinary flow rate (Q(max)), and post-void residual urine volume (PVR) at 12 months after PVP. The impact of the learning curve in terms of efficacy and morbidity following PVP were also analyzed.


RESULTS
There was a significant improvement in each outcome variable after surgery. The median (25% and 75%) values of the improved rate (IR) at 12 months after PVP were 75% (57%, 87%), 67% (50%, 83%), 103% (50%, 176%), and 85% (68%, 96%) in IPSS, QOL score, Q(max) and PVR, respectively. The IR in each outcome variable did not significantly change as the surgeon's experience increased. The time required for tissue vaporization of the adenoma and the total applied laser energy, along with the vaporized weight, significantly increased, but the efficiency of tissue vaporization did not increase as experience increased. A significant correlation was not evident between the learning curve and the total incidence of adverse events or blood loss following PVP.


CONCLUSIONS
PVP is a safe and effective treatment option for patients with BPH, providing good treatment efficacy and minimal bleeding, even when the surgeon has minimal experience.
Seki
Narihito
N
Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. narihito@uro.med.kyushu-u.ac.jp
Nomura
Hiroyuki
H
Yamaguchi
Akito
A
Naito
Seiji
S
D000368:Aged; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D007858:Learning; D008297:Male; D019990:Perioperative Care; D011182:Postoperative Care; D011183:Postoperative Complications; D011467:Prostate / Q000601:surgery*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014835:Volatilization