#1394

Evaluating the learning curves and clinical outcomes of prostatic urethral lift performed by experienced versus naive urologists

J. Yu¹, T. Hsieh¹, J. Hong¹, J. Chueh¹

¹National Taiwan University Hospital, Department of Urology, Taipei, Taiwan

Introduction:

The prostatic urethral lift (PUL) is a minimally invasive treatment for lower urinary tract symptoms in men due to prostatic bladder outlet obstruction. Although the clinical efficacy and advantages in preservation of sexual function, enhanced convalescence, and low complication risks have been demonstrated, limited data exists on how surgeon experience influences the learning curve and patient outcomes. While there is general agreement on the short learning curve of PUL, no formal study has been done to characterize the learning curve. We compared the learning curves and perioperative outcomes of PUL performed by an experienced versus naive urologist at a single center.

Material and methods:

From November 2022 to April 2025, 66 consecutive patients who underwent PUL at a single tertiary referral center were included in this retrospective study. Thirty-nine patients were treated by an experienced surgeon with extensive experience with PUL; 27 patients were treated by surgeons with no experience with PUL prior to this study. Patient demographics, perioperative parameters, preoperative and follow-up International Prostate Symptom Scores (IPSS) and uroflowmetry data were recorded. The cumulative summation (CUSUM) method was used to generate the learning curves for the experienced surgeon and a naive surgeon. Furthermore, multivariate logistic regression analysis was used to evaluate the association between operative time and surgical experience.

Results:

Overall, there were no significant differences between the experienced surgeon and naive surgeons in changes of pre- and post-operative IPSS, IPSS QOL (quality of life), urinary flow (Qmax), post-void residual volume (PVR); or intraoperative implant failure rates, complication rates, and retreatment rates. IPSS decreased by a median of 9. IPSS QOL decreased by a median of 2. Peak flow rate increased by a median of 4.0 ml/sec. PVR decreased by a median of 19.8 ml. There was also no significant difference in operative times between the experienced urologist and naive urologist (20 minutes vs 21 minutes, P = 0.526). CUSUM charts showed that the naive surgeon reached the turning point of the learning curve after 5 cases and the plateau after 8 cases, whereas the curve for the experienced surgeon showed no initial strong trend and then a downward trend after 25 cases. Multivariate regression analysis showed that operative time was significantly associated with numbers of implants (P = 0.003), intraoperative implant failure (P = 0.003), and the number of cases the urologist has performed (p = 0.007).