A paradigm shift in urology training: Laser endoscopic enucleation of the prostate may be easier than transurethral resection of the prostate in the learning curve of urology residents.

BACKGROUND

Comparative studies on the training of endoscopic enucleation of the prostate (EEP) and transurethral resection of the prostate (TURP) are scarce. EEP's challenging learning curve has limited its adoption to experienced urologists. Understanding its learning dynamics during residency is essential for optimizing training. This study compares the learning curves of EEP and TURP among urology residents.

MATERIALS AND

METHODS

retrospective analysis of 129 benign prostatic hyperplasia patients who underwent TURP (n = 73) or EEP (n = 56, 34 thulium laser enucleation of the prostate and 22 holmium laser enucleation of the prostate) between May 2023 and June 2024 was conducted. All surgeries were performed under supervision by second-year urology residents with no prior experience in either procedure. Primary outcomes were resection speed (g/min) and resection ratio (%). Learning curves were assessed using cumulative summation analysis.

RESULTS

EEP had a higher resection speed (0.47 vs. 0.32 g/min) and resection ratio (63% vs. 41%) than TURP. Proficiency was reached faster with EEP (5-7 cases) than with TURP (8-12 cases). Learning curves for EEP were more consistent, whereas TURP showed greater variability. Thulium laser enucleation of the prostate had shorter operative times than holmium laser enucleation of the prostate (91 vs. 140 min). There were no significant differences in complications or urinary incontinence. Limitations were the retrospective design, small number of cases per resident, and lack of detailed staff intervention data.

CONCLUSIONS

EEP is not more difficult to learn than TURP and may offer a more predictable learning curve. Findings support incorporating EEP into residency training programs, even for residents without TURP experience.