Introduction & Objectives
\nThe adoption of holmium laser enucleation of the prostate (HoLEP) remains limited by its demanding learning curve and concerns regarding perioperative morbidity during training. We developed a Structured Training Program for Endoscopic Prostate Enucleation(STEP), a supervised stepwise pathway designed to facilitate safe acquisition of enucleation skills. This study evaluated the transferability of STEP across different institutions and its impact on surgical performance, safety, and functional outcomes.
\nMaterials & Methods
\nProspectively collected data from consecutive HoLEP procedures performed within the STEP program between December 2022 andFebruary 2026 were analyzed. A total of 525 procedures were included: 407 performed by an expert proctor and 118 by three trainee surgeons (78, 21, and 19 cases, respectively). Training was conducted in both a high-volume private center and a tertiary public hospital, enabling assessment of transferability. The study was conducted in accordance with the Declaration of Helsinki, and ethics committee approval was waived according to local regulations The primary endpoint was enucleation efficiency (EE, g\/min).Secondary outcomes included complications, catheterization time, length of stay, continence, anejaculation, PSA, Qmax, and de novo urethral stricture. Learning curve progression was evaluated using cumulative sum (CUSUM) analysis.
\nResults
\nEnucleation efficiency was significantly higher in the expert cohort than in trainee cohorts (2.8 \u00b1 1.3 vs 1.3 \u00b1 0.6, 1.2 \u00b1 0.8, and 1.7 \u00b10.9 g\/min; p<0.001). However, this did not translate into worse clinical outcomes. Length of stay (1.21 vs 1.15\u20131.45 days; p=0.42)and catheterization time (1.56 vs 1.46\u20132.45 days; p=0.31) were comparable among groups. At 6 months, PSA reduction and postoperative Qmax were similar across cohorts (PSA p=0.18; Qmax p=0.62), indicating equivalent bladder outlet deobstruction. Major complications (Clavien\u2013Dindo \u2265III) were uncommon, with no differences within 30 days (p=0.43) or beyond 30 days (p=0.76).Continence improved in all groups, with very low 12-month incontinence rates (p=0.118). De novo urethral stricture rates were similarly low (3.2%, 2.6%, 0%, and 5.3%; p=0.86). CUSUM analysis demonstrated ongoing improvement in trainee performance, although none reached the expert efficiency benchmark during the study period.
\nConclusions
\nSTEP is a reproducible and transferable HoLEP training pathway. Although surgical efficiency remains lower during the learning phase, patient safety, functional outcomes, and complication rates are preserved. These findings support the implementation of structured training programs to facilitate wider dissemination of endoscopic prostate enucleation without compromising clinical outcomes.<\/p>","protected":false},"excerpt":{"rendered":"
Introduction & Objectives The adoption of holmium laser enucleation of the prostate (HoLEP) remains limited by its demanding learning curve and concerns regarding perioperative morbidity during training. We developed a Structured Training Program for Endoscopic Prostate Enucleation(STEP), a supervised stepwise … read more<\/a><\/p>","protected":false},"author":3,"featured_media":273,"menu_order":0,"template":"","meta":{"_acf_changed":false},"portfolio-type":[17],"portfolio-tag":[],"class_list":["post-272","portfolio","type-portfolio","status-publish","has-post-thumbnail","hentry","portfolio-type-highlight-session-1"],"acf":[],"_links":{"self":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio\/272","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio"}],"about":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/types\/portfolio"}],"author":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/users\/3"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media\/273"}],"wp:attachment":[{"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/media?parent=272"}],"wp:term":[{"taxonomy":"portfolio-type","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-type?post=272"},{"taxonomy":"portfolio-tag","embeddable":true,"href":"https:\/\/ice26.eposter.civired.com\/en\/wp-json\/wp\/v2\/portfolio-tag?post=272"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}