Abstract: PD23-02
Sources of Funding: none

Introduction

Recently, transurethral enucleation with bipolar (TUEB) was developed to enable adenoma enucleation in hospitals that do not have laser systems. The TUEB loop consists of a spatula attached to the standard tungsten wire loop, which allows urologists to perform endoscopic blunt adenoma enucleation with arrest of bleeding. This would be the first and largest study to assess 2-year outcomes and the learning curve from a single surgeon&[prime]s experience with 584 consecutive patients who underwent TUEB for benign prostatic hyperplasia (BPH).

Methods

We retrospectively assessed the perioperative outcomes and 2-year follow-up data of patients with BPH treated with TUEB. Between December 2011 and August 2016, 584 consecutive patients underwent TUEB for BPH, performed by a single surgeon. The patients were preoperatively assessed in terms of the International Prostate Symptom Score (IPSS), quality of life score (QOLs), serum prostate-specific antigen (PSA) level, and uroflowmetry parameters. Intraoperative and postoperative outcomes were also evaluated. Early and late postoperative complications were recorded. The patients were evaluated at the 3-, 12-, and 24-month follow-up by using IPSS, QOLs, and uroflowmetry.

Results

The mean (± standard error) age was 69.6 ± 0.26 years; estimated prostate volume, 54.7 ± 0.90 cm3 (range, 23-160 cm3); operative time, 58.0 ± 1.1 min; and prostatic specimen weight, 30.6 ± 0.68 g. The overall efficiency of the TUEB procedure (prostatic specimen weight [grams] / operative time [minutes]) was 0.54 ± 0.01 g/min. The efficiency increased proportionally with the weight of the prostatic specimen. TUEB appears to have a steep learning curve, and the efficiency of the procedure increased markedly and remained stable when the experience level exceeded 50 cases. The PSA reduction before and after the operation was 80.2% ± 0.78%. The maximum flow rate (26.7 ± 1.3 mL/s, p < 0.001), mean flow rate (15.5 ± 0.45 mL/s, p < 0.001), IPSS (3.8 ± 0.19, p < 0.001), and QOLs (1.0 ± 0.06, p < 0.001) significantly improved at the 2-year follow-up compared with the baseline values. None of the patients experienced persistent stress incontinence or needed autologous and homologous blood transfusion after TUEB.

Conclusions

TUEB represents an effective and safe alternative enucleation technique for the complete removal of adenomatous prostate tissue in patients with BPH, regardless of gland size. The relief from bladder outlet obstruction also proved to be durable after the 2-year follow-up.

Funding

none