Transurethral Enucleation with Bipolar for Benign Prostatic Hyperplasia: 2-Year Outcomes and the Learning Curve of a Single Surgeon's Experience of 603 Consecutive Patients.

Abstract

To investigate perioperative outcomes, the learning curve, and 2-year follow-up after transurethral enucleation with bipolar (TUEB) for patients with benign prostatic hyperplasia (BPH). From December 2011 to October 2016, 603 consecutive patients underwent TUEB for BPH, performed by a single surgeon. Patients were preoperatively assessed by using the International Prostate Symptom Score (IPSS), quality-of-life score (QOLs), serum prostate-specific antigen (PSA), and uroflowmetry evaluation. Intra- and post-operative outcomes were also evaluated. Early and late complications were postoperatively recorded. Patients were evaluated at 3, 12, and 24 months of follow-up by using IPSS, QOLs, and uroflowmetry evaluations. TUEB efficiency was defined as prostatic specimen weight (grams) per operative time (minute) (g/min). Differences were compared by using Student's t-test for continuous values. Mean age of patients was 69.6 ± 0.26 years, and estimated prostate volume was 54.7 ± 0.90 cc. Mean operative time was 57.5 ± 1.1 minutes, and mean prostatic specimen weight was 30.5 ± 0.68 g. Overall TUEB efficiency was 0.54 ± 0.01 g/min, and it improved markedly when the experience level exceeded 50 cases. Only three patients required hospital stay (0.49%). PSA level reduction before and after operation was 82.6% ± 0.70%. Significant improvement occurred in maximum flow rate (26.7 ± 1.3 mL/s, p < 0.0001), average flow rate (15.5 ± 0.45 mL/s, p < 0.0001), IPSS (3.8 ± 0.19, p < 0.0001), and QOLs (1.0 ± 0.06, p < 0.0001) at the 2-year follow-up compared with preoperative baseline values. No patients required transfusion after TUEB. TUEB represents an effective and a safe surgical procedure. The relief from bladder outlet obstruction also proved to be durable after the 2-year follow-up.