# Bipolar resection versus enucleation of the prostate in management of benign prostatic hyperplasia patients with large-sized prostates: a prospective randomized controlled clinical trial

## TL;DR

This study compares two prostate surgery methods for large prostates, finding that bipolar enucleation offers better results but more side effects.

## Contribution

The study provides new evidence that bipolar enucleation outperforms bipolar TURP in large prostate management.

## Key findings

- Bipolar enucleation showed greater improvement in urinary symptoms and flow rates compared to bipolar TURP.
- Bipolar enucleation had shorter operative times and less irrigation volume than bipolar TURP.
- Retrograde ejaculation was more common after bipolar enucleation compared to bipolar TURP.

## Abstract

Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia (BPH), but its efficacy decreases in large prostates. Bipolar enucleation of the prostate (BipolEP) has been introduced as a modification enabling complete adenoma removal and potentially superior outcomes. This study compared the efficacy and safety of bipolar TURP (B-TURP) and BipolEP in patients with large prostate volumes (≥ 80 mL).

Seventy patients with prostate volume ≥ 80 mL and bladder outlet obstruction were prospectively randomized to undergo either B-TURP (n = 37) or BipolEP (n = 33). Both procedures were performed using standardized bipolar platforms. Postoperative management followed uniform bladder irrigation and catheterization protocols. Primary outcomes were functional parameters (IPSS, Qmax, PVR), while secondary outcomes included perioperative parameters and complications. ANCOVA analysis adjusting for baseline IPSS and Qmax, and Post-hoc power analysis were performed.

Both groups showed significant postoperative improvement in IPSS, Qmax, and PVR (p < 0.001). Compared with B-TURP, BipolEP achieved a greater reduction in IPSS (p = 0.04) and higher postoperative Qmax (p = 0.004). Operative time, irrigation volume, catheterization duration, and residual tissue were all significantly lower in the BipolEP group (p < 0.05). Retrograde ejaculation occurred more frequently after BipolEP (81.8% vs. 48.6%, p = 0.004), whereas other complications were comparable. ANCOVA confirmed that between-group differences in IPSS and Qmax remained significant after adjusting for baseline values.

In patients with large prostates, BipolEP offers superior functional outcomes and improved perioperative efficiency compared with B-TURP, though at a higher risk of retrograde ejaculation. These findings support BipolEP as a preferred surgical option for large-volume BPH.

The study is registered in clinical trials (ClinicalTrials gov ID: NCT05330156 ; Registered on April 15, 2022).

The online version contains supplementary material available at 10.1186/s12894-025-02004-1.