The prospective evaluation of learning curve of bipolar anatomic endoscopic prostate enucleation (AEEP) with Herrmann's vapoenucleation probe.

We aimed to evaluate the learning curve of Bipolar Endoscopic Prostate Enucleation (BIPOLEP) in benign prostate enlargement without a mentorship.

The prospective data of 55 patients underwent BIPOLEP surgery by a single surgeon during 3 years were evaluated. The demographic, peri-operative and follow-up data were recorded. Trifecta was defined as a combination of complete enucleation and morcellation within < 90 min and without any conversion to standard TURP. Pentafecta was defined as a combination of Trifecta without postoperative complications or stress urinary incontinence at 3 months. The learning curve was considered to have been overcome when the surgeon obtained Trifecta/Pentafecta in four consecutive patients.

The mean age of the study group was 67.9 ± 6.8 years with mean prostate volume of 102.3 ± 56.4 ml. The mean operation time and enucleation time were 103.5 ± 41.1 and 65.78 ± 22.6 min, respectively. Trifecta and Pentafecta were achieved in 23rd (from 19th to 23rd) and 34th (from 30 to 34th) patients, respectively. Among the seven consecutive patients between Trifecta and Pentafecta, prostate capsule perforation was occurred during the surgery in four patients (26th, 27th and 29th patients). The mean follow-up duration was 16.7 ± 6.4 (3-24 months, range) months. Urethral stricture was observed in four (7. 2%) patients while bladder neck contracture was observed 1 (1.8%) patient. After the 3rd month, no patient reported stress incontinence.

Bipolar endoscopic enucleation of prostate is a safe surgical method and has similar and/or short learning curve compared to HOLEP even without a mentorship program.

World journal of urology. 2024 Mar 06*** epublish ***

Eda Tokat, Cenk Acar, Serhat Gurocak, Zafer Sinik

University of Health Sciences, Ankara Training and Research Hospital, Department of Urology, Ankara, Turkey. ., Hisar Intercontinental Hospital, Department of Urology, Istanbul, Turkey., Gazi University School of Medicine, Department of Urology, Section of Pediatric Urology, Ankara, Turkey., Odak Hospital, Department of Urology, Denizli, Turkey.