# Morcellation Efficiency Across Prostate Size Categories in Holmium Laser Enucleation of the Prostate (HoLEP): A Complete-Case Analysis of 255 Consecutive Procedures at a UK Tertiary Centre

## TL;DR

This study shows that removing prostate tissue becomes slower as prostate size increases, which can help surgeons plan procedures more effectively.

## Contribution

The study quantifies morcellation efficiency across prostate size categories and identifies a significant decrease in efficiency for larger glands.

## Key findings

- Morcellation efficiency significantly decreases in prostates larger than 150 cc compared to smaller sizes.
- Efficiency inversely correlates with prostate volume (ρ=−0.26, p<0.001).
- Pairwise comparisons show significant differences between <80 cc and >150 cc, and 80-150 cc and >150 cc groups.

## Abstract

Background: Mechanical morcellation is integral to Holmium Laser Enucleation of the Prostate (HoLEP). Understanding how morcellation efficiency varies with gland size can inform list planning, device selection, and safety preparedness.

Objective: To quantify morcellation efficiency across preoperative prostate size categories and examine its association with gland volume.

Methods: We performed a retrospective, single-centre, complete-case analysis of 255 consecutive HoLEP procedures at a UK tertiary centre (January 2022-January 2025). Preoperative transrectal ultrasound (TRUS) prostate volume was categorised as <80 cc, 80-150 cc, and >150 cc. Morcellation efficiency (g/min) was calculated as enucleated tissue weight divided by morcellation time. Group differences were assessed nonparametrically with Kruskal-Wallis and Bonferroni-adjusted pairwise tests, and the relationship between volume and efficiency was evaluated with Spearman’s ρ.

Results: Size distribution was <80 cc 51 (20.0%), 80-150 cc 141 (55.3%), and >150 cc 63 (24.7%). Median morcellation efficiency decreased across categories: 9.02 (IQR 6.37-13.25) vs 8.71 (IQR 6.00-12.21) vs 7.00 g/min (IQR 4.25-9.57) (Kruskal-Wallis H=13.23, p=0.001); pairwise differences were significant for <80 vs >150 (p=0.005) and 80-150 vs >150 (p=0.003), but not <80 vs 80-150 (p>0.999). Efficiency inversely correlated with volume (ρ=−0.26, p<0.001).

Conclusions: Morcellation efficiency decreases as glands become very large (>150 cc); anticipating slower retrieval in mega-prostates can guide list composition, staffing, and morcellator/technique choice.