Prostatic morcellation after HoLEP Enucleation: efficiency and safety of Storz DrillCut vs. Jena Surgical Multicut Solo.

BACKGROUNDS: Holmium laser enucleation of the prostate (HoLEP) is a widely accepted technique for treating benign prostatic hyperplasia (BPH). Developed in the 1990s, its safety and efficiency have improved with adenoma morcellation. Multiple morcellation devices exist, with oscillatory systems offering higher efficiency and safety. Notable among these are the DrillCut Storz™ (DC) and the Multicut SOLO Jena Surgical™ (MC). Currently, evidence on the efficiency of MC is limited, and no comparative analysis exists between oscillatory morcellators. The objective of this study is to compare the morcellation efficiency (g/min) of the DC and the MC. A secondary objective was to assess intraoperative injury rates associated with both morcellators.

METHODS

Prospective, observational, non-randomised cohort that included patients over 40 years old with a surgical indication for BPH, recruited from the Urology Department at Hospital Italiano de Buenos Aires (October 2023-June 2024). Dependent variables analyzed were morcellation efficiency and complications whereas independent variables were age, surgical time, PSA, prostate volume, PSA density, prior medication, urinary catheter use, and prostate cancer findings.

RESULTS

A total of 264 patients were included (mean age: 70.1 years). The DC group had 98 patients whilst the MC group had 165 patients. Average morcellation time was 7.3 min (DC) and 9.1 min (MC) (p = 0.110). Mean adenoma weight morcellated was 49.9 g (DC) vs. 69.4 g (MC) (p < 0.001). Efficiency (g/min) was 10.5 (MC) vs. 8.3 (DC) (p < 0.001). Average surgical time was 84.4 min (DC) vs. 82 min (MC) (p = 0.541). Four intraoperative complications occurred in the DC group (4.1% vs. 0%; p = 0.005). All were minor bladder lacerations without postoperative management changes.

CONCLUSIONS

The MC demonstrated superior efficiency and a lower rate of complications. However, incidence of complications was low in both groups, supporting the safety of both devices.