Wide discrepancies between reported and actual resected prostate weight in HoLEP: a call for standardized reporting.

PURPOSE: Measurements of prostate volume and weight are essential for surgical planning, outcome assessment, clinical practice, research, and guideline development in holmium laser enucleation of prostate. Yet, the reporting of both features is not standardized. Our objective was to illustrate these inconsistencies by comparing the weight of the resected prostate tissue measured in the operating room with the weight reported by pathology.

METHODS

We conducted a prospective multicenter study of 409 holmium laser enucleation of prostate procedures performed across 4 medical centers. For each case, the two weight measurements were compared while the pathologists were blinded to the study, and the scales were well-calibrated. Statistical analyses were performed.

RESULTS

The median operating room weight was 58 g (IQR 40–83), significantly lower than the median pathology weight of 71 g (IQR 50–100; p < 0.001). Pathology weight exceeded operating room measurements in 90% of cases, with an average overestimation of 19%±21%. This discrepancy was consistent across all centers and prostate size subgroups (p < 0.001). The time to pathology processing did not correlate with the magnitude of discrepancy (p > 0.6). Agreement between the compared weights was high (ICC = 0.95, p < 0.001), and correlation was strong (r = 0.957). A regression model (R²=0.92, p < 0.001) allowed derivation of a calibration formula to estimate operating room weight from pathology-reported weight.

CONCLUSIONS

Pathology reports systematically overestimate the true weight of the tissue removed during holmium laser enucleation of prostate. We propose using the operating room weight or the adjusted pathology weight calculated with our formula as a new reporting standard.