The complications of the HoLEP learning curve. A systematic review

Background: Holmium laser enucleation of the prostate (HoLEP) could have better outcomes with decreased complication rates if compared to traditional techniques (transurethral resection and open prostatectomy) for the surgical relief of bladder outlet obstruction. Despite this, its use has not been implemented in the urology community, probably due to the high complication rates of the HoLEP learning curve (HoLC). Objective: To conduct a systematic review of the complication rates in HoLC and compare these with those of traditional techniques. Evidence acquisition: a systematic literature search was performed in MedLine and Embase using the search terms "HoLEP" and "holmium laser enucleation". We identified 680 records and selected 15 studies following PRISMA criteria. Evidence synthesis: 1705 cases in the learning curves of 59 surgeons were analyzed. Most of the studies do not report complications in a standardized way. Intraoperative complication rates are low and usually without long-term impact. Postoperative complication rates are limited and show improvement with practice. The complication rates in the HoLC are similar or lower to those reported by traditional techniques. Conclusion: Complication rates in HoLC are not higher than those reported by traditional techniques. HoLEP learning should not be delayed for fear of increasing complications or their severity. (C) 2019 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.