Supplementary Material for: A Programmatic Approach to En Bloc Transurethral Enucleation of the Prostate with Bipolar System (TUEB): A Single-Center Retrospective Report

Introduction: This study presents a systematic approach for en bloc transurethral enucleation of the prostate utilizing a bipolar system (TUEB), evaluating its effectiveness and safety. Furthermore, the research aims to pinpoint risk factors contributing to early stress urinary incontinence (SUI) after undergoing en bloc TUEB. Methods: The en bloc TUEB procedure is visually demonstrated through images and videos. A retrospective analysis was conducted based on the data of 88 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent en bloc TUEB between January 2018 and April 2023. Detailed perioperative and follow-up clinical data were collected and analyzed. Patients were categorized based on the occurrence of SUI, and their clinical characteristics were analyzed. Results: The mean surgical duration was 113.1 ± 50.0 minutes, resulting in an excised prostate gland weighing 58.0 ± 34.3 g and a hemoglobin drop of 14.3 ± 11.2 g/L. The average enucleation rate was 79.00 ± 11.01 %, enucleation efficiency was 0.54 ± 0.26 g/min and prostate specific antigen (PSA) reduction rate was 42.08 ± 22.85 %. There were no major complications during operation. Twenty-three patients (26.13%) developed early SUI after catheter removal, and 74% of them were in remission within 1 month. Importantly, no cases of persistent SUI were observed. Lower urinary tract symptoms (LUTS) duration was significantly different between patients with and without post-operative SUI. Residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were significantly improved in BPH patients after surgery (P < 0.05). Twelve months after surgery, only 2 patients (2.27%) had urethral stricture, although it recovered after transurethral dilation. Conclusions: En bloc TUEB is proven to be effective, practical, efficient and safe with minimal complications. This procedure could be standardized and widely adopted. LUTS duration can predict the risk of early SUI.