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Journals / Endoüroloji Bülteni / 2026 / Cilt: 18 Sayı: 3

Association Between Comorbidity Burden and Tissue-Adjusted Enucleation Time During HoLEP: A Retrospective Cohort Study

HoLEP Sırasında Komorbidite Yükü ile Doku Yüküne Göre Düzeltilmiş Enükleasyon Süresi Arasındaki İlişki: Retrospektif Kohort Çalışması

Yunus Kayalı(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-7836-0490
Tahsin Batuhan Aydoğan(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-2000-7790
Alpcan Torun(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0009-0009-9496-8867
Fatih Bıçaklıoğlu(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0001-7175-713X
Bilal Çetin(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-2618-2258
Onur Erdemoğlu(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0001-7080-8601
Uğur Yılmaz(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0009-0005-3630-2320
Bilal Eryıldırım(UNIVERSITY OF HEALTH SCIENCES, İSTANBUL KARTAL DR. LÜTFİ KIRDAR HEALTH RESEARCH CENTER, DEPARTMENT OF SURGICAL MEDICAL SCIENCES, THE DEPARTMENT OF UROLOGY)0000-0002-2213-3985
Pages
160–175
Publication Date
2026-09-30
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Efficiency was calculated as enucleation efficiency (g/min; primary outcome), morcellation efficiency (g/min), and overall extraction efficiency (g/min).

📌 3 Key Takeaways

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Objective & Hypothesis:Objective: To quantify phase-specific operative efficiency in holmium laser enucleation of the prostate (HoLEP) and assess the association between comorbidity burden and efficiency metrics.
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Key Findings & Data:Material and Methods: This single-center retrospective cohort included HoLEP cases performed between January 2023 and June 2025.
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Conclusion & Impact:Efficiency was calculated as enucleation efficiency (g/min; primary outcome), morcellation efficiency (g/min), and overall extraction efficiency (g/min).
🔬Design:Modeling & Simulation
📍Scope:2023 Verileri
⚙️Variables:Holmium lazer prostat enükleasyonu (HoLEP) · benign prostat hiperplazisi · operasyon süresi

Abstract

Objective: To quantify phase-specific operative efficiency in holmium laser enucleation of the prostate (HoLEP) and assess the association between comorbidity burden and efficiency metrics. Material and Methods: This single-center retrospective cohort included HoLEP cases performed between January 2023 and June 2025. Of 574 screened patients, 349 met eligibility criteria. Efficiency was calculated as enucleation efficiency (g/min; primary outcome), morcellation efficiency (g/min), and overall extraction efficiency (g/min). Associations were evaluated using multivariable linear regression models after natural log transformation of skewed efficiency outcomes, adjusted for age, log-transformed enucleated tissue weight, and prostate-volume (PV) stratum. Results: Median age was 67 years and 67.9% had ≥1 comorbidity. Median enucleated tissue weight was 53.0 g; median enucleation efficiency was 1.12 g/min, morcellation efficiency 7.00 g/min, and overall extraction efficiency 0.96 g/min. Enucleation efficiency increased across PV strata (0.86 to 1.75 g/min; p<0.001). Patients with any comorbidity had lower enucleation efficiency than those without (0.93 vs 1.75 g/min; p<0.001). Each additional comorbid condition was independently associated with a 5.9% decrease in enucleation efficiency (p=0.001). Hypertension and prior prostate cancer were associated with reduced enucleation efficiency (−11.4% and −55.7%, respectively). Conclusion: Higher comorbidity burden is independently associated with lower HoLEP enucleation efficiency beyond prostate size and tissue burden. Phase-specific efficiency metrics may facilitate risk-adjusted benchmarking and operating-room planning.

Özet

Amaç: HoLEP’te faza özgü cerrahi verimlilik metriklerini tanımlamak ve komorbidite yükünün verimlilik ile ilişkisini değerlendirmek. Gereç ve Yöntemler: Tek merkezli retrospektif kohortta Ocak 2023–Haziran 2025 arasında uygulanan HoLEP olguları incelendi. Taranan 574 hastanın 349’u analize alındı. Verimlilik; enükleasyon verimliliği (g/dk; birincil sonlanım), morselasyon verimliliği (g/dk) ve toplam ekstraksiyon verimliliği (g/dk) olarak hesaplandı. Komorbidite ile ilişki; çarpık dağılım gösteren verimlilik sonlanımlarının doğal log dönüşümü sonrası çok değişkenli lineer regresyon modelleri kullanılarak yaş, log(enükle edilen doku ağırlığı) ve prostat hacmi (PV) stratumuna göre düzeltilerek değerlendirildi. Bulgular: Medyan yaş 67 idi ve hastaların %67.9’unda ≥1 komorbidite vardı. Medyan enükle edilen doku 53.0 g; medyan enükleasyon verimliliği 1.12 g/dk, morselasyon verimliliği 7.00 g/dk ve toplam ekstraksiyon verimliliği 0.96 g/dk bulundu. PV arttıkça enükleasyon verimliliği yükseldi (0.86’dan 1.75 g/dk’ye; p<0.001). Komorbiditesi olanlarda enükleasyon verimliliği daha düşüktü (0.93 vs 1.75 g/dk; p<0.001). Her ek komorbidite, enükleasyon verimliliğinde %5.9 azalma ile ilişkiliydi (p=0.001). Hipertansiyon ve prostat kanseri öyküsü enükleasyon verimliliğini azalttı (−%11.4 ve −%55.7). Sonuç: Komorbidite yükü, prostat hacmi ve doku yükünden bağımsız olarak HoLEP enükleasyon verimliliğini azaltır. Faza özgü verimlilik metrikleri risk-ayarlı karşılaştırma ve ameliyathane planlamasında kullanılabilir.

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Cite This Article

Kayalı, Y., Aydoğan, T. B., Torun, A., Bıçaklıoğlu, F., Çetin, B., Erdemoğlu, O., Yılmaz, U., Eryıldırım, B. (2026). Association Between Comorbidity Burden and Tissue-Adjusted Enucleation Time During HoLEP: A Retrospective Cohort Study. Endoüroloji Bülteni, Cilt: 18 Sayı: 3, 160–175. https://doi.org/10.54233/endourolbull-1898671

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