Efficacy analysis and learning curve of holmium laser enucleation of the prostate with the en-bloc technique by a junior surgeon

Yongsheng Pan; Bo Liu; Siyang Xu; Jie Jiang; Zhan Chen; Lin Wang; Tianle Wang; Wei Xue; Hua Zhu; Bing Zheng

doi:10.32604/cju.2026.084223

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Efficacy analysis and learning curve of holmium laser enucleation of the prostate with the en-bloc technique by a junior surgeon

Yongsheng Pan^1,2,#, Bo Liu^3,#, Siyang Xu^1,2,#, Jie Jiang^1,2, Zhan Chen^1,2, Lin Wang^2,4, Tianle Wang^2,4, Wei Xue^1,2,4, Hua Zhu^1,2,*, Bing Zheng^1,2,*
1 Department of Urology, Nantong First People’s Hospital, Nantong, China
2 Department of Urology, Affiliated Nantong Clinical College of Nantong University, Nantong, China
3 Department of Urology, Yining County People’s Hospital, Yining, China
4 Department of Radiology, Nantong First People’s Hospital, Nantong, China
5 Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
* Corresponding Author: Hua Zhu. Email: email ; Bing Zheng. Email: email
# Yongsheng Pan, Bo Liu and Siyang Xu contributed equally to this work

Canadian Journal of Urology https://doi.org/10.32604/cju.2026.084223

Received 18 April 2026; Accepted 27 August 2026; Published online 20 September 2026

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Abstract

Backgrounds: Holmium laser enucleation of the prostate (HoLEP) is recommended as a surgical option for benign prostatic hyperplasia (BPH), but its steep learning curve hinders clinical adoption and widespread use. Objective: This study aims to analyze the efficacy, safety, and learning curve of en-bloc HoLEP performed by a junior surgeon across 61 consecutive cases. Methods: A retrospective analysis was conducted on 61 consecutive BPH patients who underwent en-bloc HoLEP performed by a junior surgeon at our center between June and December 2024. Enucleation efficiency was defined as enucleation weight divided by enucleation time. Cumulative sum (CUSUM) analysis was adopted to stratify learning stages based on slope changes of the CUSUM curve, and Locally Estimated Scatterplot Smoothing (LOESS) was used for visualizing the overall trend of enucleation efficiency. The learning process was categorized into three stages: initial (cases 1–20), transitional (cases 21–40), and proficient (cases 41–61). The three groups were compared regarding baseline characteristics, perioperative parameters, complications, and six-month postoperative outcomes. Results: All 61 procedures were completed successfully without conversion to open surgery or transurethral resection of the prostate (TURP). Enucleation efficiency improved significantly across the three stages (0.71 ± 0.19 vs. 1.00 ± 0.22 vs. 1.28 ± 0.37 g/min, p < 0.001). Prostate volume was significantly larger in the proficient stage (93.54 ± 30.61 mL) than in the initial (67.72 ± 11.26 mL) and transitional (71.90 ± 18.29 mL) stages (both p < 0.05). Perioperative complication rates were comparable across the three groups (p > 0.05). At the 6-month follow-up, no significant inter-stage differences were observed in International Prostate Symptom Score (IPSS), post-void residual volume (PVR), or peak urinary flow rate (Qmax) among the three groups (p > 0.05), though all parameters had significantly improved relative to preoperative baseline values (p < 0.05). Conclusions: En-bloc HoLEP is safe and effective for BPH. A junior surgeon can preliminarily master this technique after approximately 20 cases, and enter a phase of rapid efficiency improvement after 40 consecutive cases.