Step 4 of bipolar anatomical endoscopic enucleation of prostate. This step is in my personal opinion the most delicate and difficult step to understand and master. The anterior commissure is incised and the sphincter is released from the adenoma. It is not easy to find the correct plane because in this location the fibres of the sphincter are attached to the fibres of the adenoma. The step is delicate as a damage of the sphincter has to be avoided. it is not easy to keep the correct orientation of the incision. This approach can be useful (to me it was) in the beginning of this experience as the lateral attachments to the upper part of the lobes are carefully prepared. The following incision of the mucosa of the lobes is made under direct and continuous visual control. All this releases the sphincter from the lateral lobes without any mechanical stress, preparing for the next step: the enucleation of the lateral lobes.
