title: Clinical and Pathological Characteristics of Hard Nodules Resistant to Morcellation During Holmium Laser Enucleation of the Prostate.
abstract: OBJECTIVE
  To identify the clinical and pathological characteristics of hard nodules resistant to morcellation (HNRM) during holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH).
  
  
  METHODS
  Between July 2008 and October 2011, 246 patients underwent HoLEP for symptomatic BPH. The first 30 patients were excluded from the analysis due to the learning curve of the procedure. The remaining patients were divided into HNRM (n=29) and non-HNRM groups (n=187), and comparative analysis of the clinical parameters of the two groups was performed. International prostate symptom score analysis and urodynamic studies were performed preoperatively. Histological analysis was performed after hematoxylin and eosin staining and Masson trichrome staining of the HNRM specimens.
  
  
  RESULTS
  Twenty-nine patients (13.4%) had HNRM. The patients in the HNRM group had significantly higher proportions of advanced age (≥65 years, P=0.029), total prostate volume ≥65 mL (P<0.001), transition zone volume ≥35 mL (P<0.001), serum prostate-specific antigen levels ≥10 ng/mL (P=0.007), and functional urethral length ≥70 mm (P=0.009); larger enucleation weight (P<0.001); longer operation (P=0.001), enucleation (P=0.042), and morcellation times (P<0.001); and higher enucleation ratio (P=0.028) and enucleation efficacy (P=0.001). After adjusting for confounding factors, multivariate logistic regression analysis revealed that age ≥65 years and total prostate volume ≥65 mL were independent risk factors for HNRM. Pathological examination did not reveal any malignant cells, with mainly dense fibrous tissue found in the HNRM.
  
  
  CONCLUSIONS
  HNRM can make morcellation cumbersome and time-consuming, and older patients with larger prostates have a higher incidence of HNRM. However, the histopathology of HNRM revealed mainly fibrotic tissue.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea ; Department of Urology, Yanbian University Hospital, Yanji, China.
authors.forename: Songzhe
authors.initials: S
authors.lastname: Piao
authors.affiliation: Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
authors.forename: Min Soo
authors.initials: MS
authors.lastname: Choo
authors.affiliation: Department of Pathology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jungbum
authors.initials: J
authors.lastname: Bae
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung-June
authors.initials: SJ
authors.lastname: Oh
keywords: Laser Therapy; Prostate; Prostatic Hyperplasia; Transurethral Resection of Prostate