{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:37:05Z","timestamp":1790617025372,"version":"4.1.0"},"reference-count":34,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2024,11,1]],"date-time":"2024-11-01T00:00:00Z","timestamp":1730419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Endourology"],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>To report the surgical and functional outcomes of the holmium laser enucleation of the prostate (HoLEP) surgical program implemented at a high-volume tertiary referral center and to estimate the learning curve (LC) duration for this surgical procedure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data of all consecutive patients undergoing HoLEP at the University of Verona between June 2022 and April 2024 were retrieved from a prospectively maintained institutional database of patients undergoing benign prostatic hyperplasia (BPH) surgical treatment. The primary endpoint was functional outcomes evaluation during the surgeons\u2019 LC. The secondary endpoint was to define the surgical LC for HoLEP. A multivariable test of means was performed to compare functional outcomes at different time points. After adjusting for potential confounders (age, preoperative pharmacotherapy, and prostate volume), multivariable linear regression models were fitted to evaluate the effect of experience on operative time (OT) and enucleation efficiency. To assess LCs for HoLEP surgery, the non\u2013risk-adjusted cumulative sum (CUSUM) method was used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A statistically significant improvement in International Prostate Symptoms Score (IPSS) score, delta% IPSS score, IPSS quality of life (IPSS-QoL) score, and delta% IPSS-QoL score was observed over the study period. Furthermore, the incidence of irritative symptoms (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.001) and stress incontinence (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.01) significantly decreased over time, with a 12-month incidence of 8.4% and 9.5%, respectively. A statistically significant association between experience and both OT and enucleation efficiency was observed in multivariable linear regression analysis. The CUSUM chart for OT and enucleation efficiency showed a steep initial upward\/downward trend of \u223c50 cases each, and a plateau until \u223c100 procedures are reached, where the breakpoint is recognized for both variables and where the CUSUM curve goes below the locally weighted scatterplot smoothing curve in the corresponding observed\u2013expected CUSUM plot.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>HoLEP represents an effective treatment for BPH, demonstrating significant improvement in BPH-related symptoms over the study period, despite the considerable LC of \u223c50 cases associated with the procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/end.2024.0422","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T03:08:17Z","timestamp":1723518497000},"page":"1226-1233","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":14,"title":["The Learning Curve for Holmium Laser Enucleation of the Prostate: A Single-Center Analysis of Surgical And Functional Outcomes"],"prefix":"10.1177","volume":"38","author":[{"given":"Francesco","family":"Ditonno","sequence":"first","affiliation":[{"name":"Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Bianchi","sequence":"additional","affiliation":[{"name":"Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, 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Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Balzarro","sequence":"additional","affiliation":[{"name":"Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Rubilotta","sequence":"additional","affiliation":[{"name":"Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7045-7725","authenticated-orcid":false,"given":"Riccardo","family":"Autorino","sequence":"additional","affiliation":[{"name":"Department of Urology, Rush University, Chicago, Illinois, 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