Evaluation of the learning curve for thulium laser enucleation of the prostate with the aid of a simulator tool but without tutoring: comparison of two surgeons with different levels of endoscopic experience.

BACKGROUND: The aim of this study was to determine the learning curve for thulium laser enucleation of the prostate (ThuLEP) for two surgeons with different levels of urological endoscopic experience. METHODS: From June 2012 to August 2013, ThuLEP was performed on 100 patients in our institution. We present the results of a prospective evaluation during which we analyzed data related to the learning curves for two surgeons of different levels of experience. RESULTS: The prostatic adenoma volumes ranged from 30 to 130 mL (average 61.2 mL). Surgeons A and B performed 48 and 52 operations, respectively. Six months after surgery, all patients were evaluated with the International Prostate Symptom Score questionnaire, uroflowmetry, and prostate-specific antigen test. Introduced in 2010, ThuLEP consists of blunt enucleation of the prostatic apex and lobes using the sheath of the resectoscope. This maneuver allows clearer visualization of the enucleation plane and precise identification of the prostatic capsule. These conditions permit total resection of the prostatic adenoma and coagulation of small penetrating vessels, thereby reducing the laser emission time. Most of the complications in this series were encountered during morcellation, which in some cases was performed under poor vision because of venous bleeding due to surgical perforation of the capsule during enucleation. CONCLUSIONS: Based on this analysis, we concluded that it is feasible for laser-naive urologists with endoscopic experience to learn to perform ThuLEP without tutoring. Those statements still require further validation in larger multicentric study cohort by several surgeon. The main novelty during the learning process was the use of a simulator that faithfully reproduced all of the surgical steps in prostates of various shapes and volumes.

Prostate cancer: preliminary results of a case finding campaign.

OBJECTIVES: The objective of this study was to evaluate the feasibility of applying a case finding programme for prostate carcinoma based on a questionnaire which was sent by post to the male population of a Northern Italian region. METHODS: In November 2000 a questionnaire containing prostate related questions was sent to all men aged 55 or older residing in the area served by our hospital. Information provided by the answers was included in a specific data base. Subjects considered at risk for prostate carcinoma were invited for clinical consultation and prostate biopsy when appropriate. RESULTS: 41,627 questionnaires were sent and 7,732 were completed and returned. 960 subjects (12.4%) were considered at risk. Presently, 816 patients have been examined and 116 were biopsied. Thirty-six cases of prostate cancer were found (4.4%). DISCUSSION: The value of mass screening programmes for prostate carcinoma is still under debate and mature data from controlled screening trials must be obtained before definitive conclusions can be drawn. In the meanwhile, considering the growing public awareness, it may be advisable to activate programmes asking for information through questionnaires about prostate disease in order to find cases of undetected prostate cancer.