The Learning Curve in Transurethral Resection of Prostate (turp) – the Experience of Eight Young Urologists during a Six-years Period

Introduction and Objectives: The aim of our study was to evaluate the results of TURP performed in our department by eight young urologists during their learning curve, to assess how experience influences the quality of resection, intraoperative and postoperative complications and to appreciate which would be the minimum number of procedures until gaining satisfactory skills. Material and Methods: During a six years period, eight urologists performed 536 TURP. We analyzed these cases by following: age, estimated prostate volume (suprapubic ultrasonography), weight of resected tissue, time of resection, intraoperative complications, postoperative complications, re do TUR rate (for retention of urine after removal of catheter or for postoperative gross hematuria), lenght of hospitalisation. Results: The number of TURP procedures performed by the eight urologists increased from 25 (in the first year) to 200 (in the sixth year). The weight of resected tissue slightly increased from 20.3 grams to 29.6 grams. The time of resection decreased from 51 to 40 minutes, with a weight/time ratio increasing from 0.4 gr./ min. to 0.74 gr./min. The intraoperative complications decreased as follows: perforation of the prostate capsule: from 4% to 1% and severe intraoperative bleeding from 4% to 1%. Conversion to open surgery (caused by severe intraoperative bleeding not responsive to endoscopic hemostasis) was necessary only in one patient. The rate of re TURP procedures (for acute retention of urine after removal of catheter or for postoperative gross hematuria) decreased from 12% to 4.5%. The TURP syndrome rate was 2.6% (in the first year) and 1.5% (in the sixth year). The length of postoperative hospitalisation decreased from 4.5 days to 3.5 days. Conclusions: The “hands-on training” is the most appropriate way to achieve satisfactory skills in TURP. As in other urological procedures, the first steps are difficult, with a relative large number of complications and reinterventions. Experience leads to better results.