title: Holmium laser enucleation of the prostate and retropubic prostatic adenomectomy: morbidity analysis and anesthesia considerations.
abstract: OBJECTIVE
  Holmium laser enucleation of the prostate (HoLEP) is an alternative to prostatic adenomectomy for the surgical treatment of benign prostatic hypertrophy. We analyzed our learning curve for this technique, and we compared it in a secondary manner with prostatic adenomectomy.
  
  
  METHODS
  A retrospective comparative study was conducted that included the first 100 cases of HoLEP performed in our center and the latest 50 cases of retropubic adenomectomy. We collected data on the patients, the surgery, the anesthesia, the perioperative variables, the anesthesia complications and the postoperative variables, with a 6-month follow-up. We analyzed the learning curve without mentors for HoLEP and compared the characteristics of HoLEP in 2 separate phases (learning and stabilization phases) with the latest retropubic prostatic adenomectomies performed.
  
  
  RESULTS
  Intradural anesthesia was the most common technique. The transfusion needs, length of stay (P<.01) and postoperative morbidity were lower for HoLEP than for adenomectomy. However, the retropubic adenomectomy group had larger initial prostate volumes (P<.001) and shorter surgical times (P<.001). Better surgical performance (P<.001) and a lower incidence of complications were observed in the HoLEP-B group (once the learning curve had been overcome) compared with the HoLEP-A group.
  
  
  CONCLUSIONS
  In our center, HoLEP was introduced as a valid alternative to open retropubic adenomectomy, with excellent results in terms of morbidity and reduced hospital stay. In terms of the learning curve, we consider that approximately 50 patients (without mentor) is an appropriate cutoff. Local anesthesia is a good choice for the anesthesia technique.
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España. Electronic address: diegosotomesa@yahoo.es.
authors.forename: D
authors.initials: D
authors.lastname: Soto-Mesa
authors.affiliation: Servicio de Neurología, Fundación Hospital de Jove, Gijón, España.
authors.forename: M
authors.initials: M
authors.lastname: Amorín-Díaz
authors.affiliation: Servicio de Anestesiología y Reanimación, Hospital de Cabueñes, Gijón, España.
authors.forename: L
authors.initials: L
authors.lastname: Pérez-Arviza
authors.affiliation: Servicio de Urología, Hospital de Cabueñes, Gijón, España.
authors.forename: S
authors.initials: S
authors.lastname: Fernández-Pello Montes
authors.affiliation: Servicio de Urología, Hospital de Cabueñes, Gijón, España.
authors.forename: A
authors.initials: A
authors.lastname: Martín-Huéscar
mesh_terms: D000368:Aged; D000758:Anesthesia; D006801:Humans; D053844:Lasers, Solid-State / Q000009:adverse effects* / Q000627:therapeutic use*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012189:Retrospective Studies
keywords: Adenomectomía prostática; Anestesia regional; Benign prostatic hyperplasia; Blood transfusion; Enucleación prostática mediante láser de holmio; Hiperplasia benigna de próstata; Holmium laser enucleation of the prostate; Local anesthesia; Prostatic adenomectomy; Transfusión sanguínea; Urology; Urología