Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

Abstract

Objective

The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate, investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency, and seek to determine the optimal interval between the two surgeries.

Methods

This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g, indicative of substantial prostate enlargement. Morcellation was performed on Day 0 ( n=4), Day 4 ( n=1), Day 6 ( n=1), and Day 7 ( n=3). The intervals were compared regarding the morcellation efficiency, beach ball presence, and pathology.

Results

The mean estimated prostate volume was 383 (range 330–528) mL; the median enucleation weight was 252 (interquartile range [IQR] 222, 342) g; and the median enucleation time was 83 (IQR 62, 100) min. The mean morcellation efficiency was 1.44 (SD 0.55) g/min on Day 0 and 13.69 (SD 2.46) g/min on day 7. The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6, respectively, with significantly higher in the two-stage group compared to one-stage group (11.0 g/min vs. 1.5 g/min; p=0.014). Efficiency was strongly correlated with intervals ( p<0.001); the incidences of beach balls were 100% (4/4) and 60% (3/5) in the immediate and two-stage surgery groups, respectively.

Conclusion

The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval, with the maximum efficiency reached on Day 7.