title: [XPS Greenlight photoselective vaporization for benign prostatic hyperplasia: analysis of the learning curve and contribution of transrectal ultrasound monitoring].
abstract: BACKGROUND
  The aim of this study was to analyze the XPS laser learning curve of one single surgeon with no previous experience of PVP and the impact of the use of reel time transrectal ultrasound (TRUS) monitoring.
  
  
  METHODS
  Retrospective analysis of the first 100 patients: group 1 (1st-49th patient without TRUS) and group 2 (50th-100th with TRUS). The learning curve was analyzed through technical variables: vaporization time/intervention time (VT/IT) (%), energy delivered (J)/prostate volume (J/mL) and delivered energy (J/s or Watt), peroperative conversion into monopolar transurethral resection, postoperative complication, duration of catheterization and hospitalization and evolution of International Prostate Symptom Score (IPSS), PSA level, prostate residual volume and Qmax. Relationships between variables were evaluated by analysing the covariance (R 2 software. 14.2).
  
  
  RESULTS
  A significant increase in VT/IT (P=0.0001) and the energy delivered per mL prostate (P=0.043) was reported in group 1. The average energy delivered per second was significantly higher in group 2 (P=0.0016). No difference was observed in terms of intra- or postoperative complication and catheterization time. The duration of hospitalization was significantly shorter in group 2 (P=0.03). The use of TRUS was associated with a gain of energy delivered by prostate volume at the end of learning curve (P=0.018). Prostate residual volume was significantly lower in the group 2 (P=0.0004).
  
  
  CONCLUSIONS
  In our experience, 50 procedures are required to achieve the learning curve of PVP. The use of reel time TRUS would increase the energy delivered by prostate volume.
authors.affiliation: Service d'urologie, clinique Pasteur, 40, avenue de Lombez, 31300 Toulouse, France. Electronic address: v.misrai@clinique-pasteur.com.
authors.forename: V
authors.initials: V
authors.lastname: Misrai
authors.forename: M
authors.initials: M
authors.lastname: Faron
authors.forename: B
authors.initials: B
authors.lastname: Elman
authors.forename: B
authors.initials: B
authors.lastname: Bordier
authors.forename: D
authors.initials: D
authors.lastname: Portalez
authors.forename: J
authors.initials: J
authors.lastname: Guillotreau
mesh_terms: D000368:Aged; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011467:Prostate / Q000000981:diagnostic imaging* / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional
keywords: Benign prostate hypertrophy; Courbe d’apprentissage; Endoscopic surgery; Hypertrophie bénigne de prostate; LASER; Laser; Learning curves; Résection transurétrale de prostate