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Abstract：
OBJECTIVE: To evaluate the early learning curve of BipolEP (Bipolar Enucleation of the Prostate).
METHODS: We conducted a retrospective, multicenter analysis of surgical and functional outcomes of patients treated with BipolEp for BPO (benign prostatic obstruction). We evaluated the first 20 cases of BipolEp performed by four different surgeons in three different countries. The following baseline parameters were obtained: age, IPSS, indwelling catheter, transrectal measured prostate volume, post void residual volume (PVR) and uroflowmetry. The learning curve was analysed based on perioperative parameters and the influence of perioperative parameters was correlated with the sequence of BipolEp cases.
RESULTS: 84 BipolEp operations performed by 4 different surgeons in their early learning curve were studied. Mean prostate volume was 75 ml, 39% of cases had an indwelling catheter and the average operating time was 101 min. Three out of four surgeons performed at least 50% of successful operations according to Trifecta (complete enucleation and morcellation < 90 min., no conversion to TUR-P). Conversion rate to TURP was 11.9% in total which however was driven by a single surgeon with an almost 50% conversion rate. Mean enucleated prostate was 33.3 gr (18-54.5). Intraoperative complications and reported stress incontinence ranged from 0 to 38.1%. At six-weeks review, the IPPS improved by 12.5 (8-16) points and Qmax by 208% (109.8-266.7). Uroflowmetry outcomes correlated with the sequence of cases with a linear improvement during 20 consecutive cases (p = 0.018) in all centres. Major complications (Clavien Dindo ≥ 3) were rare (4.8%) and comparable between the groups.
CONCLUSIONS: Surgeons starting to learn BipolEp can expect to be able to achieve a linear improvement in Uroflow at the six-week postoperative evaluation after 20 consecutive cases. BipolEp can be successfully performed during the early learning curve with an acceptable rate of conversion to standard TUR-P.
METHODS: We conducted a retrospective, multicenter analysis of surgical and functional outcomes of patients treated with BipolEp for BPO (benign prostatic obstruction). We evaluated the first 20 cases of BipolEp performed by four different surgeons in three different countries. The following baseline parameters were obtained: age, IPSS, indwelling catheter, transrectal measured prostate volume, post void residual volume (PVR) and uroflowmetry. The learning curve was analysed based on perioperative parameters and the influence of perioperative parameters was correlated with the sequence of BipolEp cases.
RESULTS: 84 BipolEp operations performed by 4 different surgeons in their early learning curve were studied. Mean prostate volume was 75 ml, 39% of cases had an indwelling catheter and the average operating time was 101 min. Three out of four surgeons performed at least 50% of successful operations according to Trifecta (complete enucleation and morcellation < 90 min., no conversion to TUR-P). Conversion rate to TURP was 11.9% in total which however was driven by a single surgeon with an almost 50% conversion rate. Mean enucleated prostate was 33.3 gr (18-54.5). Intraoperative complications and reported stress incontinence ranged from 0 to 38.1%. At six-weeks review, the IPPS improved by 12.5 (8-16) points and Qmax by 208% (109.8-266.7). Uroflowmetry outcomes correlated with the sequence of cases with a linear improvement during 20 consecutive cases (p = 0.018) in all centres. Major complications (Clavien Dindo ≥ 3) were rare (4.8%) and comparable between the groups.
CONCLUSIONS: Surgeons starting to learn BipolEp can expect to be able to achieve a linear improvement in Uroflow at the six-week postoperative evaluation after 20 consecutive cases. BipolEp can be successfully performed during the early learning curve with an acceptable rate of conversion to standard TUR-P.
摘要：
目的：评估BipolEP（前列腺双极摘除术）的早期学习曲线。
方法：我们进行了回顾性研究，BipolEp治疗BPO（良性前列腺梗阻）患者的手术和功能结果的多中心分析。我们评估了由三个不同国家的四位不同外科医生进行的前20例BipolEp。获得以下基线参数：年龄，IPSS,留置导管,经直肠测量前列腺体积，后空隙残余体积（PVR）和尿流仪。根据围手术期参数分析学习曲线，围手术期参数的影响与BipolEp病例顺序相关。
结果：研究了由4位不同外科医生在其早期学习曲线中进行的84次BipolEp手术。平均前列腺体积为75ml,39％的病例有留置导管，平均手术时间为101分钟。根据Trifecta，四分之三的外科医生至少完成了50％的成功手术（完全摘除和粉碎<90分钟。,没有转换为TUR-P)。TURP的转化率为11.9％，但由一名外科医生驱动，转化率几乎为50％。平均去核前列腺为33.3gr（18-54.5）。术中并发症和报告的压力性尿失禁的范围为0至38.1％。在六周的审查中，IPPS提高了12.5（8-16）点，Qmax提高了208%（109.8-266.7）。在所有中心的20个连续病例（p=0.018）中，尿流量测定结果与病例序列相关，线性改善。主要并发症（ClavienDindo≥3）很少见（4.8％），两组之间具有可比性。
结论：开始学习BipolEp的外科医生可以期望在连续20例病例的术后六周评估中能够实现尿流量的线性改善。BipolEp可以在早期学习曲线期间成功执行，具有可接受的转换为标准TUR-P的速率。
方法：我们进行了回顾性研究，BipolEp治疗BPO（良性前列腺梗阻）患者的手术和功能结果的多中心分析。我们评估了由三个不同国家的四位不同外科医生进行的前20例BipolEp。获得以下基线参数：年龄，IPSS,留置导管,经直肠测量前列腺体积，后空隙残余体积（PVR）和尿流仪。根据围手术期参数分析学习曲线，围手术期参数的影响与BipolEp病例顺序相关。
结果：研究了由4位不同外科医生在其早期学习曲线中进行的84次BipolEp手术。平均前列腺体积为75ml,39％的病例有留置导管，平均手术时间为101分钟。根据Trifecta，四分之三的外科医生至少完成了50％的成功手术（完全摘除和粉碎<90分钟。,没有转换为TUR-P)。TURP的转化率为11.9％，但由一名外科医生驱动，转化率几乎为50％。平均去核前列腺为33.3gr（18-54.5）。术中并发症和报告的压力性尿失禁的范围为0至38.1％。在六周的审查中，IPPS提高了12.5（8-16）点，Qmax提高了208%（109.8-266.7）。在所有中心的20个连续病例（p=0.018）中，尿流量测定结果与病例序列相关，线性改善。主要并发症（ClavienDindo≥3）很少见（4.8％），两组之间具有可比性。
结论：开始学习BipolEp的外科医生可以期望在连续20例病例的术后六周评估中能够实现尿流量的线性改善。BipolEp可以在早期学习曲线期间成功执行，具有可接受的转换为标准TUR-P的速率。
