Technical aspects of transurethral plasmakinetic enucleation and resection of the prostate for benign prostatic hyperplasia

TUERP, which is based on TURP, technically has been proven to be safe and effective with reduced complication rates. Due to the lack of systematic pre-clinical training, the surgery is learnt only inside the operative theatre in the majority of the Chinese medical centers. It is also known to have a steep learning curve, and very few articles have addressed the technical aspects of TUERP. Material and methods: The videos of 91 cases of bipolar transurethral enucleation and resection of the prostate, which were performed by one urological surgeon in our department from August 2013 to January 2016, were retrospectively analyzed. With an extensive review of the literature and based on the summary of our experience, detailed techniques and tips for TUERP are described. Results: The procedure is initiated from the enucleation of mid-lobe and progressed in a retrograde mode with the guide of the capsular plane. Along with the experience accumulated, the capability of landmark identifying and the surgical skills were improved. Conclusion: A steep operative learning curve may be the main obstacle to the widespread use of TUERP. Accurate identification and orientation of the landmark with good understanding of the three-dimensional structure of the prostatic fossa and the detailed technical issues of enucleating along the right capsule plane will be helpful for beginners to overcome the learning curve and gain confidence with this procedure and for experienced surgeons to further improve their surgical technique.