Endoscopic enucleation of the prostate made practical: lessons from experts from the BEAM25 meeting

Endoscopic enucleation of the prostate (EEP) is the gold standard surgical treatment for benign prostatic obstruction irrespective of prostate size. However, numerous technical challenges may arise during EEP due to anatomical variability, patient-specific factors, and prior interventions. This study aims to summarize expert-derived surgical strategies to facilitate safe implementation of EEP and optimize outcomes in both novice and experienced surgeons.

This expert consensus paper is based on structured panel discussions held during the BEAM 2025 meeting. Recommendations were collected from international high-volume EEP surgeons, each with experience exceeding 1,000 procedures. Practical tips and strategies were compiled, reviewed, and approved by the expert panel, focusing on training, equipment, surgical technique, case selection, and management of complex scenarios. No formal Delphi or voting-based methodology was used; therefore, this manuscript reflects a structured expert-opinion consensus.

Key recommendations include adopting an anatomical mindset distinct from resection techniques, structured training with full operating room team involvement, and appropriate equipment selection. Guidance is provided for managing the learning curve, optimizing patient counseling, maintaining anatomical orientation, and addressing technical challenges during enucleation and morcellation, particularly in large, small, or anatomically complex prostates. Strategies to prevent and manage common perioperative complications are also outlined.

Expert-driven practical guidance may shorten the EEP learning curve, enhance procedural safety, and improve functional outcomes. Adoption of these recommendations can support broader implementation of EEP in routine clinical practice.