Bipolar enucleation of the prostate—step by step

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.