En Bloc Bipolar Prostate Enucleation Using the Mushroom Technique with Early Apical Release: Short-Term Outcomes

Background and Objectives: While transurethral resection of the prostate remains the gold standard for surgical treatment of benign prostatic hyperplasia, anatomical endoscopic enucleation of the prostate provides a safe, durable, and size-independent alternative. Our study introduces a specific technical innovation, i.e., en bloc bipolar prostate enucleation performed exclusively via sheath-tip mechanical dissection without the use of a dedicated enucleation loop, combined with the mushroom technique and early apical release. Materials and Methods: Between January 2018 and May 2023, 252 patients with prostate volumes > 30 mL and significant lower urinary tract symptoms underwent en bloc bipolar prostate enucleation via the mushroom technique with early apical release. Data were retrospectively evaluated to assess perioperative results, postoperative outcomes, and complications. Results: The median age of the cohort was 70 (65-76) years, with a median prostate volume of 60 (40-88.5) mL. The median operative time was 40 (30-70) min, and the median weight of enucleated tissue was 34 (16.5-60) g. Significant improvements were observed in the International Prostate Symptom score, Quality of Life score, maximum flow rate, average flow rate, and postvoid residual urine at 12 months (p < 0.001). The rate of transient stress urinary incontinence decreased from 19.44% at 1 month to 2.38% at 12 months. Conclusions: En bloc bipolar prostate enucleation using the mushroom technique is a safe and effective treatment for benign prostatic hyperplasia, yielding significant improvements in urinary symptoms and flow rates, with a manageable complication profile. Further multicenter studies are needed to confirm these findings.