Establishing an endoscopic enucleation of the prostate practice: a survey of strategies and challenges by successful early career urologists

Introduction: Endoscopic Enucleation of the Prostate (EEP) remains a size independent technique for the treatment of Benign Prostatic Hyperplasia (BPH) with many benefits. Adoption has lagged behind other interventions due to a purported steep learning curve and high cost of equipment. The Prostate Enucleation Collaborative (PEC) is a group of early career urologists which formed in 2024 to promote EEP education and research. Here we report the results of a survey of PEC members addressing common practice patterns and member experiences early in their learning curve to help aspiring non-EEP practitioners begin a successful EEP practice. Methods: In August 2024, a survey, developed by the authors, of preoperative, perioperative, and postoperative management of EEP patients, as well as the challenges associated with implementation of an EEP program, was distributed to all members of PEC. Results: 13 of 16 (81%) PEC members completed the survey; 9 (69.2%) performed EEP from the start of practice, while 4 (30.8%) adopted it later. Most initially see patients in person with validated symptom scores and imaging to confirm prostate size, but rarely urodynamics. Members recommended limiting the initial 50 cases to under 150 gm. Perioperatively, 69.2% hold anticoagulation if safe, and most use pulse-modulated holmium lasers. About half perform EEP as outpatient surgery, with 84.6% attempting a trial of void on postoperative day 1. Follow-up is commonly at 3 months (53.8%), and 92.3% check prostate-specific antigen (PSA) postoperatively. Conclusions: These findings provide preliminary, practical guidance for surgeons starting an EEP practice, highlighting strategies such as reviewing operative videos, engaging mentors for early case support and anticipating institutional barriers such as equipment acquisition and workflow integration that may affect program development. Although drawn from a small cohort, these insights offer useful direction for novice EEP surgeons during their initial learning curve.