AEEP involves the complete separation and removal of the obstructing adenoma along the surgical capsule from the remainder of the prostate. HoLEP was the first AEEP technique described and gained the most traction, with HoLEP and ThuLEP having the most robust data available. Numerous other techniques have been described for AEEP and may be viable alternatives to HoLEP and ThuLEP. Bipolar enucleation of the prostate (BipolEP) has been compared to TURP, HoLEP, and ThuLEP. BipolEP has also been called transurethral bipolar enucleation (TUBE), but these are equivalent procedures and will be referred to as “bipolar enucleation” throughout. Bipolar enucleation showed a similar improvement in IPSS, quality of life, and Qmax compared to TURP, and showed a significant improvement in PVR compared to TURP at one year. There was no significant difference in adverse events, including postoperative blood transfusion, urethral stricture, and urinary incontinence.293 Bipolar enucleation did show a statistically higher amount of resected prostatic tissue of 13.65 g compared to TURP (p=0.001).323 Compared to HoLEP, one RCT of 107 men showed bipolar enucleation had similar improvement in IPSS and quality of life scores, as well as no significant difference between PVR and Qmax at 1-year follow-up. There were no differences between adverse events during the perioperative period.324 Finally, bipolar enucleation was compared to ThuLEP which showed no significant difference between PVR and Qmax at one year. There was a small statistical difference in total IPSS favoring ThuLEP during short-term follow-up between 3-12 months, but this difference was not maintained at 12 months.325, 326 Finally, bipolar enucleation was compared to open simple prostatectomy (OSP), with similar improvement in IPSS and quality of life between the two groups at one year, with a small, but statistically significant difference in quality of life favoring bipolar enucleation (0.9 points versus 1.1 points). There was no statistically significant difference in postoperative long-term adverse events with more patients requiring a blood transfusion following OSP compared to bipolar enucleation (7.5% versus 1.25%, respectively; RR: 0.17; 95% CI: 0.02 to 1.35).293 Beyond bipolar enucleation, multiple alternative laser technologies other than HoLEP and ThuLEP   have been used for AEEP and include diode laser enucleation of the prostate (DiLEP), thulium-fiber enucleation of the prostate (ThuFLEP), KTP/LBO laser enucleation of the prostate (GreenLEP), and numerous other variations using a variety of other technologies. DiLEP has been described, but data was not captured in the systematic review for this Guideline. There was one trial comparing DiLEP to B-TURP with similar improvements in IPSS, quality of life, Qmax, and PVR at one year. Regarding complications, there were no significant differences in the postoperative complication rates, and there were no statistically significant difference in complications at one year.327 In a systematic review from Pallauf et al., there were no statistically significant differences in total IPSS and Qmax between DiLEP, HoLEP, ThuLEP, and bipolar enucleation of the prostate.323 ThuFLEP was compared to HoLEP which showed no statistically significant difference in total IPSS at 12 months. Data was limited and too heterogenous to pool, but across the studies, there were no significant differences in quality of life, Qmax, or PVR between the two technologies. Additionally, there were no significant differences in post-surgical or long-term adverse events at 18 months.328-331 GreenLEP has been compared to HoLEP which showed similar improvement in IPSS, quality of life, PVR, and Qmax at three years of follow-up. There was also no significant difference in perioperative or long-term adverse events between the two techniques.332, 333 A systematic review was performed comparing GreenLEP to PVP, with GreenLEP showing no significant improvements in IPSS or quality of life between the two techniques, but noting a significantly greater improvement in PVR, Qmax, and PSA compared to PVP.334 The Panel recognizes AEEP as a surgical technique that can be performed using various technologies and techniques to achieve a similar intraoperative outcome. Unfortunately, the Panel also recognizes that individual technologies and techniques carry their own unique risks, therefore patients should be counseled about the limited short- and long-term data when utilizing technologies that have limited reporting on comparative information available. The decision to perform these procedures must be based on the expertise and experience of the clinician as well as equipment availability.