Prostate tissue retrieval after holmium laser enucleation of the prostate; assessment of non-morcellation approaches

http://dx.doi.org/10.1016/j.aju.2016.03.001 2090-598X 2016 Arab Association of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). This paper by Elshal et al. [1] addresses one of the main difficulties that face surgeons during a holmium laser enucleation of the prostate. Unfortunately, although morcellation is associated with many hurdles, such as malfunction or inefficiency of the morcellator, in addition to complications that range from mucosal lacerations to bladder perforation, the alternatives are seldom addressed in the literature. In this paper [1], the authors attempted to develop an algorithm for alternatives to morcellation, which most authorities in this field would agree with. In all, 9.4% of their cases required an alternative to morcellation, highlighting that morcellation can be an unreliable procedure, and making this work valuable. However, the methodology that the authors used to develop this algorithm is less than ideal. They depended on their past experience in a retrospective manner to develop this algorithm without any effort to test it in a prospective study. The relative efficiency of the two alternatives investigated in comparison with each other and with the standard of care, the morcellation, was not tested. The comparison of the two techniques is a biased one, as the authors used the ‘mushroom technique’ for smaller adenomas and retrieval through cystostomy for large adenomas. In summary, although this study [1] addresses an important topic and serves as a basis for future research, the approach that the authors used needs to be verified by a prospective study.