Finding my surgical path: Highlights and outcomes of the BPO masterclass

The masterclass was an intensive two-day programme devoted entirely to the surgical management of benign prostatic obstruction (BPO), from guideline-anchored indications through hands-on simulation to a demanding programme of live and semi-live surgery. 

As an early-career specialist, I came to Como already familiar with the core BPO procedures but, honestly, feeling uncertain and unsure in my decision-making. Being able to see and compare every technique side by side was the single most valuable aspect for me: from weighing the different laser systems and morcellators in theory to seeing them applied in live surgery.

Day one progressed from indications and functional evaluation through the full treatment armamentarium — from minimally invasive options to the main enucleation platforms — followed by an invaluable hands-on simulator afternoon. Day two featured focused head-to-head live surgery, allowing the leading techniques and energy sources to be compared directly.

Scientifically, the clearest thread was the convergence of EEP: whatever the energy source, the operation is the same; developing the plane at the surgical capsule, enucleating the adenoma, then morcellating. The EAU Guidelines already position EEP as a size-independent option, and the course reinforced why: the outcome depends on the anatomical plane and the surgeon, not the wavelength. Morcellation emerged as the true rate-limiting and complication-prone step.

Overall, it was a real upgrade in how I view bladder outlet obstruction with new techniques, a practical approach to patient selection, and a genuine opportunity to compare methods: from established approaches to modern minimally invasive procedures. The emphasis on individualising therapy and choosing the optimal pathway, rather than adopting a "one-size-fits-all" approach, stood out. Meetings like this allow you to step beyond routine and think about BPO more strategically — as a whole treatment process, not a single procedure. I return full of ideas and concrete takeaways that I can apply to my daily practice.

The faculty were outstanding. They were open, helpful, and willing to answer every question, however basic. My special thanks go to Prof. Arkadiusz Miernik (DE) and Dr. Davide Perri (IT). Como itself added real charm; the atmosphere and congress dinner were perfectly judged, and the fellow attendees were another highlight. The masterclass was a chance to exchange experiences, support one another, and build new connections.

The effect on my practice has been concrete. Above all, the masterclass showed me how much it matters to have a mentor standing behind you; that confidence alone has translated into shorter operating times and better efficacy. I now perform enucleation regularly and am beginning to offer Rezūm as well. It was a genuine catalyst that clarified my direction: I now see myself firmly on the path to becoming an endourologist.

One area further development would be the balance between presentations and interactive discussion, with more opportunities for audience participation, and the hands-on (HOT) sessions could also benefit from a clearer structure and smaller groups, as the number of participants occasionally made the flow somewhat challenging. A more interactive format — engaging the audience, working through real cases, and using video examples — would strengthen future editions.

I would recommend this masterclass without hesitation to any urologist looking to build or further a BPO surgical practice, and especially to those early in their journey.