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

doi:10.1016/j.ajur.2023.04.005

Asian Journal of Urology, 2024, 11 (3): 423-428 doi: 10.1016/j.ajur.2023.04.005

Regular Papers: Original Articles

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

Fumiyasu Endo^a,*(

),Masaki Shimbo^a,Kenji Komatsu^a,Kazuhiro Ohwaki^b,Kazunori Hattori^a

^aDepartment of Urology, St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, Japan
^bDepartment of Hygiene and Public Health, Teikyo University School of Medicine Graduate School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan

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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.

Key words： Holmium laser enucleation of the prostate Reciprocating morcellator Giant adenoma Two-stage surgery

Received: 27 November 2022 Available online: 20 July 2024

Corresponding Authors: *E-mail address: endofum@luke.ac.jp (F. Endo).

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Fumiyasu Endo,Masaki Shimbo,Kenji Komatsu, et al. Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate[J]. Asian Journal of Urology, 2024, 11(3): 423-428.

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http://www.ajurology.com/EN/10.1016/j.ajur.2023.04.005 OR http://www.ajurology.com/EN/Y2024/V11/I3/423

Patients' background and surgical results.

Relationship between morcellation efficiency and surgical interval. The morcellation efficiency was strongly correlated with the number of days. For case #2, data on the first morcellation were used for analysis.

Surgical parameters and the presence of beach balls.

Pathological findings after surgery in case #2, in which surgery was interrupted due to hypothermia and two morcellation procedures were performed. (A and B) Immediately after surgery: gross appearance following fixation (A) and microscopic findings with hematoxylin and eosin staining (B); (C and D) Day 7 after surgery: gross appearance following fixation (C) and microscopic findings with hematoxylin and eosin staining (D). There was little change in appearance immediately and on Day 7, but microscopic findings showed that epithelial cells were degraded by necrosis in the delayed specimens.

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