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Inicio Actas Urológicas Españolas (English Edition) The complications of the HoLEP learning curve. A systematic review
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Vol. 44. Issue 1.
Pages 1-8 (January - February 2020)
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Vol. 44. Issue 1.
Pages 1-8 (January - February 2020)
Review article
The complications of the HoLEP learning curve. A systematic review
Análisis de las complicaciones en el aprendizaje del HoLEP: revisión sistemática
F. Agreda Castañeda
Corresponding author

Corresponding author.
, O. Buisan Rueda, J.J. Areal Calama
Servei d’Urologia, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
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Figures (2)
Tables (5)
Table 1. Clavien-Dindo classification of postoperative complications adapted to HoLEP.
Table 2. Summary of included studies and characteristics of each series.
Table 3. Summary of intraoperative complications.
Table 4. Summary of postoperative complications.
Table 5. Summary of complications by type and author during and after completing the HoLEP learning curve.
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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).


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

Analysis of 1705 cases in the learning curves of 59 surgeons. 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.


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.

Benign prostatic hyperplasia
Learning curve

La enucleación prostática con laser de Holmio (HoLEP) podría mejorar los resultados y tener menores tasas de complicaciones que las técnicas tradicionales (resección transuretral y prostatectomía abierta) en la desobstrucción quirúrgica prostática. A pesar de esto, su uso no se ha extendido en la urología a nivel mundial. La alta tasa de complicaciones en su curva de aprendizaje (CAHo) podría ser una causa.


hacer una revisión sistemática para determinar las tasas de complicaciones en el aprendizaje de HoLEP y compararlas con las descritas en técnicas tradicionales. Adquisición de la evidencia: se realizó una búsqueda bibliográfica en MedLine y Embase con los términos “HoLEP” y “holmium laser enucleation”. Se obtuvieron 680 registros, y siguiendo los criterios PRISMA se seleccionaron 15 estudios.

Síntesis de la evidencia

se analizaron 1705 casos en la curva de aprendizaje de 59 urólogos. La mayoría de los estudios no hacen un reporte estandarizado de las complicaciones. Las complicaciones intraoperatorias son bajas y en general no tienen repercusiones a posterior. Las tasas de complicaciones postoperatorias son bajas y mejoran con la experiencia. Las tasas de complicaciones en CAHo son iguales o menores a las reportadas en las técnicas tradicionales.


las tasas de complicaciones en la CAHo no superan a las reportadas en las técnicas tradicionales. El aprendizaje de HoLEP no debe ser retrasado por temor a aumentar las complicaciones o su severidad

Palabras clave:
Hiperplasia prostática benigna
Curva de aprendizaje


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