Transurethral Anatomical Enucleo-resection of the Prostate (TUAERP) is a well-established surgical technique for managing benign prostatic enlargement (BPE), particularly in prostates larger than 80 mL, as recommended by the European Association of Urology (EAU) Guidelines. In Malaysia, while bipolar resectoscopes are widely available, access to holmium lasers and morcellators remains limited due to financial constraints. As a result, Bipolar TUAERP serves as a cost-effective and practical alternative for large prostate cases in this setting.

A case series was conducted to evaluate the learning curve of a single urology resident performing Bipolar TUAERP at Sarawak Heart Centre and Sarawak General Hospital from May 1, 2024, to August 15, 2024. The procedures were initially performed under supervision (mentor scrubbed: 5 cases; mentor present but not scrubbed: 3 cases) before transitioning to independent practice (7 cases). Patient demographics, operative parameters, and perioperative outcomes were analysed.

Fifteen cases were assessed, comparing the supervised (8 cases) and independent (7 cases) phases. The mean patient age was 72.4 vs. 68.7 years, prostate volume 88.5g vs. 61.6g, and PSA level 10.6 ng/ml vs. 4.6 ng/ml (p=0.008) in the supervised and independent phases, respectively. Mean operative time was 150 vs. 102 minutes, enucleation efficacy 1.3g/min vs. 1.1g/min, and resection efficacy 0.7g/min vs. 0.6g/min. No blood transfusions were required. Bladder irrigation duration was 1.13 vs. 1 day (p=0.049), and hospital stay averaged 1.38 vs. 1 day (p=0.005). Most parameters showed no significant differences, except PSA levels, bladder irrigation duration, and hospital stay. The en-bloc enucleation step is demonstrated in the attached video.

With structured mentorship, the learning curve for Bipolar TUAERP can be shortened to 15 cases, significantly less than the 25-50 cases reported in the literature. Proper supervision enables a smoother transition to independent practice while maintaining low complication rates, making Bipolar TUAERP a feasible option in resource-limited environments.