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Systematic review of the endoscopic enucleation of the prostate learning curve

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Abstract

Introduction

It has been shown that endoscopic enucleation of the prostate (EEP) allows for similar efficacy and safety, no matter what energy and type of instruments we use, but the length of learning may differ greatly. The aim of this systematic review is to verify if there is any significant difference between EEP methods in learning.

Evidence acquisition

We performed a systematic literature search in three databases and included only the articles containing their own data on the EEP learning curve assessment during the last 10 years. The primary endpoint was to determine the necessary experience needed to achieve a plateau. The secondary endpoints were to review methods used to evaluate a learning curve.

Evidence synthesis

The final sample included 17 articles, containing a total of 4615 EEPs performed by 76 surgeons, the most common method was HoLEP (9/17). The majority of articles studying HoLEP report a learning curve of experience level achievement in roughly 30–40 (min 20; max 60) cases. The studies of GreenLight laser showed high heterogeneity in the results with minimum of 20 cases and maximum of 150–200 cases. TUEB required roughly 40–50 cases to reach the plateau.

Conclusion

Although EEP is considered challenging, it shows a steep learning curve with a plateau after 30–50 cases. Proper criteria are critical for accurate assessment of the learning curve. The Trifecta and Pentafecta criteria are currently the most appropriate method to evaluate EEP learning.

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Abbreviations

EEP:

Endoscopic enucleation of the prostate

TURP:

Transurethral resection of the prostate

RPE:

Radical prostatectomy

TUEB:

Transurethral enucleation with bipolar

HoLEP:

Holmium laser prostate enucleation

ThuLEP:

Thulium-YAG prostate enucleation

ThuFLEP:

Thulium fiber laser prostate enucleation

MEP:

Monopolar prostate enucleation

PRISMA:

Preferred reporting items of systematic reviews and meta-analyses

WoS:

Web of Science

PSA:

Prostate specific antigen

BPH:

Benign prostatic hyperplasia

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Author information

Authors and Affiliations

  1. Institute for Urology and Reproductive Health, Sechenov University, 2/1, Bolshaya Pirogovskaya str, Moscow, 119991, Russia

    Dmitry Enikeev, Andrey Morozov & Mark Taratkin

  2. Department of Urology, Clinique Pasteur, Toulouse, France

    Vincent Misrai

  3. Department of Urology, Hospital Quirón Salud, Barcelona, Spain

    Enrique Rijo

  4. Moscow Regional Research and Clinical Institute Moniki N.a. M.F. Vladimirskiy, Moscow, Russia

    Alexei Podoinitsin

  5. Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia

    Svetlana Gabdullina

  6. Department of Urology, Spital Thurgau AG, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  7. Department of Urology, Hannover Medical School, Hannover, Germany

    Thomas R. W. Herrmann

Authors
  1. Dmitry Enikeev
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  2. Andrey Morozov
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  3. Mark Taratkin
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  4. Vincent Misrai
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  5. Enrique Rijo
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  6. Alexei Podoinitsin
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  7. Svetlana Gabdullina
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  8. Thomas R. W. Herrmann
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Contributions

DE: data analysis, manuscript editing, protocol development, management. AM: data collection, data analysis, manuscript writing. MT: data analysis, manuscript editing. VM: manuscript editing, protocol development. ER: data analysis, manuscript editing. AP: data analysis, manuscript editing. MA: data collection, manuscript writing. SG: data analysis, manuscript editing. TRWH: data analysis, protocol development, management.

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Correspondence to Dmitry Enikeev.

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Enikeev, D., Morozov, A., Taratkin, M. et al. Systematic review of the endoscopic enucleation of the prostate learning curve. World J Urol 39, 2427–2438 (2021). https://doi.org/10.1007/s00345-020-03451-1

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  • DOI: https://doi.org/10.1007/s00345-020-03451-1

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