Bipolar Enucleation of the Prostate Versus Transurethral Resection of the Prostate: A Prospective Randomized Controlled Noninferiority Trial
In brief
Bipolar enucleation matches TURP for symptom relief at 12 months
In a randomized trial of 84 men, both procedures brought the median symptom score to 5 at 12 months, and bipolar enucleation met the study's noninferiority threshold. It removed more prostate tissue but took longer; early minor complications were more common, while serious complications occurred only after TURP. Longer follow-up is needed to compare durability.
- Journal
- European urology focus (Q1)
- Published
- 23 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Maximilian Pallauf, David Oswald, Christian Ramesmayer, Michael Abenhardt, Maximilian Horetzky, Hubert Grießner, et al.
- PMID
- 42919758
- DOI
- 10.1016/j.euf.2026.10.009
Why clinicians should know about it
- Picked for Urology (top studies of the week, 25 October 2026): BipolEP noninferior to TURP for 12‑mo IPSS
Abstract
BACKGROUND AND OBJECTIVE: Transurethral resection of the prostate (TURP) is the standard surgical treatment for moderate-sized benign prostatic enlargement (BPE). We evaluated whether bipolar enucleation of the prostate (BipolEP) is noninferior to TURP for 12-mo symptom relief. METHODS: Open-label, two-center, parallel-group, randomized noninferiority trial: men with BPE (volume 40-150 ml; International Prostate Symptom Score [IPSS] ≥15; maximum urinary flow rate ≤15 ml/s or urinary retention), randomized 1:1 (minimization stratified by prostate size and catheterization status) to TURP or BipolEP. PRIMARY OUTCOME: 12-mo IPSS (noninferiority margin 3 points); secondary outcomes: tissue-resection efficiency (g/min) and complications (Clavien-Dindo [CD]). ANALYSES: per protocol and intention to treat. TRIAL REGISTRATION: ClinicalTrials.gov NCT03503721; funding: none. KEY FINDINGS AND LIMITATIONS: Eighty-four men were randomized (42 per arm); 66 (79%) were included in the primary per-protocol analysis. Median 12-mo IPSS score was five in both groups; the estimated difference (TURP-BipolEP) was 0 points (90% confidence interval -2 to 1), confirming noninferiority (pnon-inf = 0.02). BipolEP removed more tissue (38.4 vs 25.0 g) despite longer operative time (86 vs 67 min) and achieved modestly higher resection efficiency (0.5 vs 0.4 g/min; p = 0.007). Within 30 d, CD 1-2 were more frequent with BipolEP (54% vs 28%), whereas CD ≥3 occurred only after TURP (10%; p = 0.02). No differences in CD from 1 to 12 mo (p > 0.9). MAIN LIMITATION: follow-up duration. INTERVENTION: TURP vs BipolEP. CONCLUSIONS AND CLINICAL IMPLICATIONS: BipolEP is noninferior to TURP for 12-mo symptom relief, with greater tissue removal despite longer operative time and comparable safety. These findings support BipolEP as an alternative to TURP for moderate-sized prostates, although longer follow-up is required.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.