Bipolar enucleation of the prostate—step by step

Abstract

Bipolar enucleation of prostate (BipolEP) is a useful method for treatment of benign prostatic hyperplasia (BPH). Compared with conventional transurethral resection, the enucleation technique has several advantages. However, since the cost of laser equipment used for enucleation is relatively high, enucleation using bipolar devices has been attempted by many previous surgeons. We consider bipolar enucleation is an effective and safe procedure, and we would like to share our experience of equipment settings and procedures through this article. We will introduce the equipment and settings of BipolEP and then present the actual step-by-step procedures and surgical tips. First, circular incisions are made on bladder neck and mucosa at the level of verumontanum. Then, enucleation is performed in the order of median and lateral lobes as in laser enucleation. Haemostasis should be done throughout the procedure. After enucleation and haemostasis, prostatic tissue is evacuated by morcellator. Currently, there are several types of electrode and morcellator systems. In our experience, BipolEP has a steep learning curve but it is safe and effective procedure for managing BPH. In particular, effective haemostasis is the greatest advantage of BipolEP when compared to traditional TUR or laser enucleation.

Comparison of holmium laser enucleation with bipolar transurethral enucleation of the prostate in patients with benign prostatic hyperplasia: Results of a multicentre study

“…After the procedure, the enucleated adenomas were removed from the bladder using a mechanical tissue morcellator (Versacut™, Lumenis Inc). BipolEP was performed as previously described (Ryang et al, 2020) with a 24‐Fr continuous‐flow resectoscope (Olympus Medical Systems) under saline irrigation. We used standard and plasma enucleation electrodes.…”

Tur-P Ve Bi̇polep Uygulanan Hastalarin Post Operati̇f Ağri Açisindan Karşilaştirilmasi

“…Transüretral prostat rezeksiyonu (TUR-P), bening prostat hiperplazisin (BPH)'de altın standart tedavi yöntemidir (1). Bipolar prostat enükleasyonu (Bipo-lEP); BPH tedavisinde TUR-P operasyonuna önemli bir alternatiftir (2). Prostatın transüretral enükleasyonu ilk olarak Hiraoka ve Akimoto tarafından denenmiştir (3).…”

“…EAU kılavuzları, prostat boyutu >30 mL olan erkeklerde BPH cerrahi tedavisi için BipolEP'i alternatif bir yöntem olarak göstermektedir (1). TUR-P ve BipolEP yöntemlerinde benzer cihazlar kullanılır (2). BipolEP yönteminde diğer endoskopik enükleasyon yöntemlerinde olduğu gibi farklı araç ve malzemelere ihtiyaç duyulmamaktadır (7).…”

Bipolar transurethral resection of large prostate >100 gm: single center experience

“…laser device) that might not be available in all centers and may be associated with higher costs and longer learning curve. 8 In these settings, the current study aims to assess the safety and efficacy of B-TURP in the management of patients with large prostates (>100 g) based on a single center experience.…”