BACKGROUND: Transurethral enucleation with bipolar energy (TUEB) is one of endoscopic enucleation methods for the surgical treatment of benign prostatic hyperplasia (BPH). Authors investigated initial outcomes of TUEB performed by a single surgeon. METHODS: From 04/2016 to 06/2021, prospectively collected clinical data of 387 patients who underwent TUEB were retrospectively analyzed. TUEB was performed by transurethral resection in a saline system with a spatula loop (one-lobe enucleation technique). Patients were stratified by surgery period (early vs. late) and evaluated perioperatively. RESULTS: A total of 387 patients were included in the final analysis. Mean age was 72.4 years and total prostate volume was 73.1 cc as in the whole group. Total procedure time (116.0 vs. 116.8 min, p = 0.863), detailed procedure time (enucleation: 49.2 vs. 46.1 min, p = 0.099
morcellation: 26.5 vs. 23.6 min, p = 0.162) and enucleated tissue weight (26.1 g vs. 27.9 g, p = 0.350) did not differ significantly between groups. However, there were significant differences in enucleated tissue weight per unit time (g/min) (0.52 vs. 0.58, p = 0.037), reoperation rates due to bleeding (9.8% vs. 2.5%, p = 0.002), and conversion to transurethral prostatectomy (TURP) (19.2% vs. 1.5%, p <
0.001). At 6 months post-operatively, there were insignificant differences in the rates of de novo stress incontinence (p = 0.188), urethral stricture (p = 0.158), and bladder neck contracture (p = 0.477). CONCLUSION: TUEB is a safe and effective technique for the treatment of BPH, resulting in significant improvements in both subjective and objective symptoms. With increasing surgical experience, efficacy of the procedure has significantly improved in terms of both bleeding complication rates and TURP conversion rates. CLINICAL TRIAL NUMBER: Not applicable.