Investig Clin Urol.  2023 Jul;64(4):388-394. 10.4111/icu.20220361.

Predictive factors affecting morcellation efficiency in holmium laser enucleation of the prostate

  • 1Department of Urology, Adana Seyhan State Hospital, Adana, Türkiye
  • 2Department of Urology, Aydın State Hospital, Aydın, Türkiye
  • 3Department of Urology, Okan University Hospital, Istanbul Okan University, Faculty of Medicine, Istanbul, Türkiye
  • 4Department of Urology, Private Tınaztepe Hospital, İzmir, Türkiye
  • 5Department of Urology, Kemer State Hospital, Antalya, Türkiye


To determine the factors affecting morcellation efficiency in holmium laser enucleation of the prostate (HoLEP) surgery.
Materials and Methods
Patients who underwent HoLEP surgery by a single surgeon between 2018 and 2022 were included in the study. Our primary outcome of interest in this study was morcellation efficiency. The effect of preoperative and perioperative variables on morcellation efficiency was evaluated with linear regression analysis.
A total of 410 patients were included in the study. The mean morcellation efficiency was 6.95±1.70 g/min. Univariable and multivariable linear regression analysis was performed to identify factors affecting morcellation efficiency. Presence of the “beach ball” effect (small, round prostatic tissue fragments that are fibrotic and difficult to morcellate), the learning curve, resectoscope sheath type, prostate-specific antigen (PSA) density, morcellated tissue weight, and the presence of prostate calcification were found to be independent predictive factors (β=-1.107, 95% CI: -1.59 to -0.55, p<0.001; β=-0.514, 95% CI: -0.85 to -0.17, p=0.003; β=-0.394, 95% CI: -0.65 to -0.13, p=0.003; β=-0.302, 95% CI: -0.59 to -0.09, p=0.043; β=0.062, 95% CI: 0.05 to 0.06, p<0.001; β=-0.329, 95% CI: -0.55 to -0.10, p=0.004; respectively).
This study reports that presence of the beach ball effect, the learning curve, small resectoscope sheath, PSA density, and presence of prostate calcification negatively affect morcellation efficiency. On the contrary, morcellated tissue weight has a linear relationship with morcellation efficiency.


Benign prostatic hyperplasia; Efficiency; Holmium laser; Morcellation
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