To investigate the surgical efficiency, safety and learning curve of low-powered holmium laser enucleation of prostate (LP-HoLEP) for the treatment of benign prostatic hyperplasia (BPH) in elderly patients.

The data of 60 elderly patients with BPH who were performed by the same urologist with more than 300 trans-urethral resection of prostate and more than 150 LP-HOLEP surgeries in Xindu District People's Hospital of Chengdu from November 2019 to January 2021 were retrospectively analyzed. The patients were divided into group A, B and C according to the order of operation, with 20 cases in each group. The efficacy and safety were compared among the groups, and the learning curve of the operater was determined. One-way analysis of variance and non-parametric test were used to compare measurement data, χ² test was used for comparison of count data.

There were statistically significant differences in operation time, enucleation time and enucleation efficiency among the three groups (F=32.068, 8.652, 4.025, P < 0.05 or P < 0.01). Among the three groups, group C had the shortest operation time and enucleation time and the highest enucleation efficiency (P < 0.05). There was no significant difference in the incidence of surgery related complications among the three groups (χ²=2.682, P > 0.05). There was no significant difference in the follow-up of 3 months after operation among the three groups (P > 0.05). According to the LP-HoLEP self-learning curve, the enucleation efficiency was significantly improved with 30 surgical practices, and after 45 surgical practices, the operation level of doctors became stable.

LP-HoLEP is safe and reliable in the treatment of BPH, with few complications, complete enucleation, and wide adaptability. For urologists with endoscopic surgery experience, self-taught LP-HoLEP requires 30 surgical practices.