Benign prostatic hyperplasia (BPH) is a prevalent condition among aging males, often leading to lower urinary tract symptoms (LUTS). While transurethral resection of the prostate (TURP) has long been the standard surgical intervention, endoscopic enucleation techniques—either using bipolar electrosurgery or thulium laser—have emerged as effective and size-independent alternatives. However, limited evidence exists regarding their outcomes in patients with small prostates (<30 mL). This study aimed to compare perioperative outcomes of endoscopic enucleation between patients with small and larger prostates.

We conducted a retrospective analysis of patients who underwent either bipolar transurethral enucleation of the prostate (B-TUEP) or thulium laser enucleation of the prostate (ThuLEP) by a single surgeon between 2019 and 2020. Patients were stratified into two groups: small prostate (<30 mL) and non-small prostate (≥30 mL). Pre- and post-operative parameters including prostate-specific antigen (PSA), testosterone, voided volume (VV), peak flow rate (PFR), and post-void residual urine (RU) were collected and analyzed.

A total of 194 patients were included, with 46 (23.7%) classified in the small prostate group. No significant differences were found between the groups in most parameters, except for higher baseline and post-operative PSA and preoperative testosterone levels in the non-small prostate group. Significant improvements in VV, PFR, and RU were observed in both groups postoperatively. Notably, PSA levels significantly decreased in both cohorts, while testosterone levels remained unchanged in the non-small prostate group.

Endoscopic enucleation of the prostate provides consistent and effective symptom relief regardless of prostate size. These findings support the use of enucleation techniques, including B-TUEP and HoLEP, as viable first-line surgical options for BPH patients with LUTS, irrespective of gland volume.