Our experience in developing and implementing the beak technique, a new surgical technique for bipolar enucleation of prostate

Abstract

Objective

Transurethral bipolar enucleation of the prostate (BipolEP) is a cost-effective surgical procedure for benign prostatic hyperplasia that is highly curable. However, the surgery has a learning curve in the early stages of implementation. We named an enucleation method that utilizes the beak-like shape of the tip of a resectoscope as the “beak technique''. Our aim was to establish this new surgical technique at our hospital and to examine subsequent surgical results, including those performed by surgeons without experience in enucleation.

Patients and surgical procedure

The study participants included 102 patients who underwent BipolEP at our hospital over a 14-month period from June 2022 to August 2023. The median age of patients was 75 (55–88) years, and 50 (49 %) cases involved preoperative urinary retention. The surgery was performed by two surgeons with experience in transurethral prostate enucleation (54 cases) and five surgeons with no experience (48 cases). We shared a video explaining the Beek Technique methodology with the novice enucleation doctors in our hospital and performed the procedure.

Results

Times for median surgery, enucleation, and morcellation were 79 (37–157), 28 (8–93), and 13 (2–98) min, respectively. The median enucleation weight was 42 (6–151) g, and the median postoperative hospital stay was 4 days. Incidental prostate cancer was found in 12 cases. For those surgeons who had no prior experience with transurethral enucleation, the median surgical time was 88 (64–194) min, and the median enucleation time was 38 (16–193) min.

Conclusions

Using the beak technique, we were able to safely introduce BipolEP in a relatively short period of time, even to surgeons with no experience in enucleation surgery. We believe this method should be recommended for beginners in prostate enucleation. In addition, once proficient, a surgeon can aim for an enucleation efficiency of 2 g/min or higher.