title: Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers.
abstract: OBJECTIVE
  To compare the learning curves, perioperative and early functional outcomes after HoLEP and GreenLEP.
  
  
  METHODS
  Data from the first 100 consecutive cases treated by GreenLEP and HoLEP by two surgeons were prospectively collected from dedicated databases and analysed retrospectively. En-bloc GreenLEP and two-lobar HoLEP enucleations were conducted using the GreenLight HPS™ 2090 laser and Lumenis™ holmium laser. Patients' characteristics, perioperative outcomes and functional outcomes after 1, 3 and 6 months were compared between groups.
  
  
  RESULTS
  Total energy delivered and operative times were significantly shorter for GreenLEP (58 vs. 110 kJ, p < 0.0001; 60 vs. 90 min, p < 0.0001). Operative time reached a plateau after 30 procedures in each group. Length of catheterization and hospital stay were significantly shorter in the HoLEP group (2 vs. 1 day, p < 0.0001; 2 vs. 1 day, p < 0.0001). Postoperative complications were comparable between GreenLEP and HoLEP (19 vs. 25 %; p = 0.13). There was a greater increase of Qmaxat 3 months and a greater IPSS decrease at 1 month for GreenLEP, whereas decreases in IPSS and IPSS-Q8 at 6 months were greater for HoLEP. Transient stress urinary incontinence was comparable between both groups (6 vs. 9 % at 3 months; p = 0.42). Pentafecta was achieved in four consecutive patients after the 18th and the 40th procedure in the GreenLEP and HoLEP group, respectively. Learning curves ranged from 14 to 30 cases for GreenLEP and 22 to 40 cases for HoLEP.
  
  
  CONCLUSIONS
  Learning curves of GreenLEP and HoLEP provided roughly similar peri-operative and short-term functional outcomes.
authors.affiliation: Department of Urology, Rennes University Hospital, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Peyronnet
authors.affiliation: Department of Urology, Bordeaux Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: Grégoire
authors.initials: G
authors.lastname: Robert
authors.affiliation: Department of Urology, Bordeaux Hospital, Université de Bordeaux, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Comat
authors.affiliation: AP-HP, Hospital Pitié-Salpétrière, Service d'Urologie, 75013, Paris, France.
authors.forename: Morgan
authors.initials: M
authors.lastname: Rouprêt
authors.affiliation: CUA - Clínica CEMTRO, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gomez-Sancha
authors.affiliation: Department of Urology, Rouen University Hospital, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Cornu
authors.affiliation: Department of Urology, Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France. vmisrai@clinique-pasteur.com.
authors.forename: Vincent
authors.initials: V
authors.lastname: Misrai
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004724:Endoscopy / Q000379:methods*; D005500:Follow-Up Studies; D006695:Holmium / Q000627:therapeutic use; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D059032:Learning Curve; D016015:Logistic Models; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020728:Transurethral Resection of Prostate / Q000379:methods; D016896:Treatment Outcome
chemical_list: D006695:Holmium
keywords: Benign prostatic obstruction; Enucleation; GreenLight™; Holmium; Laser; Prostate; Surgical technique