Morcellation After Endoscopic Enucleation of the Prostate: Efficiency and Safety of Currently Available Devices

• Published in: European urology focus Vol. 8; no. 2; pp. 532 - 544
• Main Authors: Franz, Julia, Suarez-Ibarrola, Rodrigo, Pütz, Philipp, Sigle, August, Lusuardi, Lukas, Netsch, Christopher, Lehrich, Karin, Herrmann, Thomas R.W., Gratzke, Christian, Miernik, Arkadiusz
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.03.2022
• Subjects: Humans; Laser therapy; Lasers, Solid-State - therapeutic use; Male; Morcellation; Morcellation - adverse effects; Prostate - surgery; Prostatic hyperplasia; Prostatic Hyperplasia - surgery; Solid-state lasers; Transurethral Resection of Prostate; Morcellation; Solid-state lasers; Prostatic hyperplasia; Laser therapy
• ISSN: 2405-4569; 2405-4569
• DOI: 10.1016/j.euf.2021.03.021

Although several studies have compared different morcellators and enucleation techniques for the management of benign prostatic hyperplasia (BPH), there is sparse literature on morcellation, so further experimental and clinical research is required for its optimization. To critically appraise the contemporary literature on prostate morcellation and to evaluate the safety and efficiency of currently available morcellators for endoscopic enucleation of the prostate (EEP) in the context of BPH. A comprehensive review of the English and French literature relevant to prostate morcellation was performed using the PubMed-MEDLINE, Cochrane Library, Web of Science, and Wiley Online Library database from 1998 to 2020 using PICOS (patient population, intervention, comparison, outcome, and study design) criteria. We retrieved 26 studies involving 5652 patients treated with a morcellator that were eligible for data extraction and analysis. The mean patient age was 67.4 (range 61.4–72.8) yr. The weighted mean efficiency of Piranha, VersaCut, and DrillCut morcellators was 5.29, 3.95, and 5.3 g/min, respectively. Several approaches, such as en bloc, two-lobe, inverse, and improved techniques, may increase morcellation efficiency and safety. The lowest weighted mean rate of bladder wall injury was 1.24% for Piranha, followed by 1.98% for DrillCut, and 5.23% for VersaCut, while the VersaCut morcellator had the lowest weighted mean rate of device malfunction at 0.74%, compared to 2.07% for Piranha and 7.86% for DrillCut. All three morcellators are efficient and safe for prostatic morcellation after EEP. Further development of devices and techniques may improve the efficiency and safety profile of morcellation. To increase safety, surgeon expertise, technical equipment, and patient characteristics should be considered. Therefore, interdisciplinary exchange of knowledge and further technological innovations are strongly encouraged. We reviewed the safety and efficacy of devices called morcellators. These devices cut tissue into small pieces that are easier to remove from the body, and are used during laser surgery for benign enlargement of the prostate. Three morcellators are currently available on the market and are comparable in safety and efficacy. Morcellation is an efficient and safe technique for completing endoscopic enucleation of the prostate. The three morcellators currently available are comparably efficient and safe for prostatic morcellation. Further technological innovations are strongly encouraged.