Abstract
PURPOSE: To characterize the learning process by comparing the clinical outcomes and learning curves of prostatic urethral lift (PUL) performed by experienced versus naïve urologists. METHODS: Consecutive patients treated with PUL at a tertiary center by an experienced urologist with > 100 PUL cases or by naïve urologists with no prior PUL experience were included in this study. Perioperative parameters, functional outcomes, complications, and retreatment rates were compared. Learning curves were assessed using the cumulative sum (CUSUM) methodology. Multivariate regression identified predictors of operative time. RESULTS: The median operative time was 20.0 min in both groups. Overall, the International Prostate Symptoms Score total decreased by a median of 9.0 points, quality of life score decreased by a median of 2.0 points, peak urinary flow rate increased by a median of 4.3 ml/sec, and post-void residual volume decreased by a median of 19.8 ml. There were no significant differences between the two groups in functional outcomes, complication rate, or operative time. CUSUM analysis revealed a three-phase learning curve, with proficiency achieved after 5 to 8 cases. Operative time was independently associated with obstructive median lobe (P = 0.003), number of implants (P = 0.005), implant deployment failure (P < 0.001), and experience (P = 0.024). CONCLUSION: PUL can be safely and effectively performed by both experienced and naïve urologists with comparable outcomes. The learning curve is short but defined with proficiency achieved after 5 to 8 cases.