title: The impact of training on the perioperative and intermediate functional outcomes after holmium laser enucleation of the prostate.
abstract: BACKGROUND
  To systemically measure the impact of trainees' participation on the perioperative and functional outcomes after holmium laser enucleation of the prostate (HoLEP).
  
  
  METHODS
  Benign prostatic hyperplasia patients who underwent HoLEP at our department between January 2007 and January 2013 were classified based on trainee's level. Perioperative outcomes and complications were collected. Functional outcomes were assessed using the Sexual Health Inventory for Men (SHIM), International Prostate Symptom Score (IPSS), and International Continence Society-Short Form (ICSmaleSF) questionnaires. Voiding and incontinence domains of ICSmaleSF were assessed separately. Patients were divided into group 1 if no trainee participated in the operation, group 2 if a senior trainee performed the operation, and group 3 if a junior trainee participated in the operation. The patient's baseline characteristics, complications, and perioperative outcomes were compared.
  
  
  RESULTS
  There were no differences in the baseline characteristics. There were significant differences in overall operative and enucleation time (p = 0.0186, p = 0.0047, respectively) with shorter times noticed with more experienced operators. There were no differences in resected tissue weight, hemoglobin change, and transfusion rates. Postoperatively, all patients had a similar length of stay and catheterization. Complications (graded by Clavien grading system) were not different. All patients were followed up at regular intervals starting at 6 weeks, 3 months , 6 months, 1 year, and every year after that and there were no differences in flow rates or post void residual volumes at any time point. There were no differences in SHIM, IPSS, and ICSmale voiding scale among the groups. However, ICSmale continence scale was significantly different where the highest score seen in group 2.
  
  
  CONCLUSIONS
  Trainee participation in HoLEP in a controlled training environment does not compromise the safety of the procedure.
authors.affiliation: Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA.
authors.forename: Haidar M
authors.initials: HM
authors.lastname: Abdul-Muhsin
authors.forename: Mark D
authors.initials: MD
authors.lastname: Tyson
authors.forename: Karen L
authors.initials: KL
authors.lastname: Stern
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Nunez-Nateras
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
mesh_terms: D002983:Clinical Competence / Q000592:standards; D004522:Educational Status; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period / Q000523:psychology / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011470:Prostatic Hyperplasia / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D011788:Quality of Life; D020018:Sexual Dysfunctions, Psychological / Q000175:diagnosis / Q000209:etiology; D013663:Teaching / Q000592:standards; D020728:Transurethral Resection of Prostate / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000592:standards; D016896:Treatment Outcome; D014481:United States; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology