It’s all in the training: Outcomes of holmium-laser enucleation of the prostate (HoLEP) are comparable between different training methods

Objective: Training in holmium-laser enucleation of the prostate (HoLEP) is not ubiquitous in urological training programmes. We sought to investigate whether those who learn HoLEP at trainee (resident) level have similar outcomes to those who learn at consultant level. Patients and Methods: Consecutive patients undergoing HoLEP by mentorship-trained consultant surgeons and a trainee surgeon were compared to a control group of cases performed by an experienced HoLEP surgeon. Specimen weight, length of stay (LOS), stress incontinence outcomes and complication rate data were collected retrospectively for 30 HoLEP cases by each surgeon. All patients underwent follow-up after 3–6 months. Data were then compared between groups to assess for any differences in outcomes. Results: Specimen weight and prostate volume were greater ( p < 0.001) in the control group but were similar between learners. There was no difference between rates of stress urinary incontinence ( p = 0.928), complications ( p = 0.561) or LOS ( p = 0.124) between groups. Conclusion: Our data show comparable outcomes, regardless of the stage at which the surgeon trained in HoLEP. This demonstrates that learning as a trainee or a consultant is equally safe and effective, supporting the concept of HoLEP training starting from a more junior level. Level of evidence: This retrospective comparison study is level 4 evidence