{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T00:19:28Z","timestamp":1758673168466,"version":"3.44.0"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background and objectives<\/jats:title>\n<jats:p>Anatomical endoscopic enucleation of the prostate (AEEP) has revolutionized the surgical treatment of benign prostatic hyperplasia, offering advantages over transurethral prostate resection (TURP). This study aimed to compare the effectiveness of the mushroom technique versus morcellation in en bloc transurethral bipolar prostate enucleation (TUEB) for prostates\u2009&gt;\u200980\u2009mL, hypothesizing that morcellation would reduce operative time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Patients and methods<\/jats:title>\n<jats:p>We retrospectively reviewed 234 TUEB procedures performed between January 2018 and March 2024 at a tertiary university hospital. Patients were divided into two groups: the mushroom technique group (n\u2009=\u2009116) and the morcellation group (n\u2009=\u2009118). Demographic and clinical data were collected and outcomes, such as operative time, efficacy, and complications, were analyzed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The median operative time was significantly longer in the mushroom cohort (80 [60\u201390] min) than in the morcellation cohort (60 [50\u201370] min) (p\u2009&lt;\u20090.001). Efficacy, which was measured in g\/min, was higher in the morcellation group (1.25 [1.01\u20131.44] g\/min) than in the mushroom group (0.9 [0.76\u20131.03] g\/min) (p\u2009&lt;\u20090.001). Linear regression analysis showed that the prostate volume significantly influenced the operative time of the mushroom technique more than that of the morcellation technique. Complications were similar across the groups, with no need for blood transfusion or conversion to TURP.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Morcellation is an efficient method for tissue removal during bipolar prostate enucleation particularly for larger prostates, owing to its shorter operative time and consistent efficacy. Although the mushroom technique is a viable alternative, it is less efficient for larger glands. Nevertheless, both techniques demonstrated similar safety profiles and functional outcomes. Further multicenter trials are required to confirm these findings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0331142","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T17:25:04Z","timestamp":1758648304000},"page":"e0331142","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of the mushroom technique versus morcellation in en bloc bipolar prostate enucleation for prostates over 80 mL"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0816-5992","authenticated-orcid":true,"given":"Zolt\u00e1n","family":"Kiss","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1547-3028","authenticated-orcid":true,"given":"Mih\u00e1ly","family":"Mur\u00e1nyi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Nagy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tibor","family":"Flask\u00f3","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,9,23]]},"reference":[{"issue":"8","key":"pone.0331142.ref001","article-title":"Anatomical endoscopic enucleation of the prostate: the next gold standard? Yes!","volume":"52","author":"T Aho","year":"2020","journal-title":"Andrologia"},{"issue":"6","key":"pone.0331142.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0253083","article-title":"Bipolar transurethral enucleation of the prostate: is it a size-independent endoscopic treatment option for symptomatic benign prostatic hyperplasia?","volume":"16","author":"C Bebi","year":"2021","journal-title":"PLoS One"},{"issue":"7","key":"pone.0331142.ref003","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1007\/s00345-021-03705-6","article-title":"Endoscopic enucleation of the prostate (EEP). The same but different-a systematic review","volume":"39","author":"M Pallauf","year":"2021","journal-title":"World J Urol"},{"key":"pone.0331142.ref004","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s00345-020-03156-5","article-title":"Holmium laser enucleation of the prostate for very large benign prostatic hyperplasia (\u2265 200 cc","volume":"39","author":"MA Zell","year":"2021","journal-title":"). World J Urol"},{"key":"pone.0331142.ref005","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1016\/S0022-5347(05)64476-X","article-title":"Holmium laser enucleation of the prostate combined with electrocautery resection: the mushroom technique","volume":"168","author":"WW Hochreiter","year":"2002","journal-title":"J Urol"},{"issue":"1","key":"pone.0331142.ref006","doi-asserted-by":"crossref","first-page":"7","DOI":"10.52786\/isu.a.66","article-title":"Comparison of the results of bipolar transurethral enucleation and resection of the prostate with and without morcellation in treatment of benign prostatic hyperplasia","volume":"44","author":"T Weerasawin","year":"2023","journal-title":"Insight Urol"},{"issue":"1","key":"pone.0331142.ref007","doi-asserted-by":"crossref","first-page":"12","DOI":"10.12701\/yujm.2021.01522","article-title":"Anatomical endoscopic enucleation of the prostate for bladder outlet obstruction: a narrative review","volume":"39","author":"TH Kim","year":"2022","journal-title":"J Yeungnam Med Sci"},{"issue":"12","key":"pone.0331142.ref008","doi-asserted-by":"crossref","first-page":"3471","DOI":"10.1007\/s00345-023-04666-8","article-title":"Comparison of EEP and TURP long-term outcomes: systematic review and meta-analysis","volume":"41","author":"A Morozov","year":"2023","journal-title":"World J Urol"},{"issue":"11","key":"pone.0331142.ref009","doi-asserted-by":"crossref","first-page":"2977","DOI":"10.1007\/s11255-022-03218-0","article-title":"A prospective randomized controlled trial comparing the effect and safety of Piranha and VersaCut morcellation devices in transurethral holmium laser enucleation of the prostate","volume":"54","author":"Y Chen","year":"2022","journal-title":"Int Urol Nephrol"},{"key":"pone.0331142.ref010","first-page":"487","article-title":"A cost-benefit analysis of bipolar TURP for the treatment of bladder outflow obstruction","volume":"13","author":"GM Pirola","year":"2021","journal-title":"Res Rep Urol"},{"issue":"1","key":"pone.0331142.ref011","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1111\/bju.12281","article-title":"Systematic review and meta-analysis of the clinical effectiveness of bipolar compared with monopolar transurethral resection of the prostate (TURP)","volume":"113","author":"MI Omar","year":"2014","journal-title":"BJU Int"},{"issue":"5","key":"pone.0331142.ref012","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1016\/j.urology.2006.06.021","article-title":"Randomized trial comparing holmium laser enucleation of prostate with plasmakinetic enucleation of prostate for treatment of benign prostatic hyperplasia","volume":"68","author":"MG Neill","year":"2006","journal-title":"Urology"},{"issue":"3","key":"pone.0331142.ref013","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1089\/end.2016.0673","article-title":"A Prospective randomized study comparing disposable with reusable blades for a morcellator device","volume":"31","author":"B Becker","year":"2017","journal-title":"J Endourol"},{"key":"pone.0331142.ref014","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.urology.2017.05.018","article-title":"Morcellation efficiency in holmium laser enucleation of the prostate: oscillating morcellator outperforms reciprocating morcellator with no apparent learning curve","volume":"106","author":"S McAdams","year":"2017","journal-title":"Urology"},{"issue":"6","key":"pone.0331142.ref015","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1089\/end.2011.0536","article-title":"Standardized comparison of prostate morcellators using a new ex-vivo model","volume":"26","author":"M Ritter","year":"2012","journal-title":"J Endourol"},{"issue":"2","key":"pone.0331142.ref016","doi-asserted-by":"crossref","first-page":"90","DOI":"10.5213\/inj.2015.19.2.90","article-title":"Clinical and pathological characteristics of hard nodules resistant to morcellation during holmium laser enucleation of the prostate","volume":"19","author":"S Piao","year":"2015","journal-title":"Int Neurourol J"},{"issue":"1","key":"pone.0331142.ref017","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s00345-024-04902-9","article-title":"Revisiting the issue of \u201cbeach balls\u201d in holmium laser enucleation of prostate: clinical and histological characterization","volume":"42","author":"H Herzberg","year":"2024","journal-title":"World J Urol"},{"issue":"3","key":"pone.0331142.ref018","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.ajur.2023.04.005","article-title":"Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate","volume":"11","author":"F Endo","year":"2024","journal-title":"Asian J Urol"},{"issue":"2","key":"pone.0331142.ref019","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.urology.2015.04.028","article-title":"Predictors of enucleation and morcellation time during holmium laser enucleation of the prostate","volume":"86","author":"MF Monn","year":"2015","journal-title":"Urology"},{"key":"pone.0331142.ref020","doi-asserted-by":"crossref","DOI":"10.5489\/cuaj.3035","article-title":"Towards optimizing prostate tissue retrieval following holmium laser enucleation of the prostate (HoLEP): assessment of two morcellators and review of literature","volume":"9","author":"AM Elshal","year":"2015","journal-title":"Can Urol Assoc J"},{"issue":"6","key":"pone.0331142.ref021","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1016\/j.juro.2010.08.037","article-title":"Transurethral enucleation and resection of prostate in patients with benign prostatic hyperplasia by plasma kinetics","volume":"184","author":"C Liu","year":"2010","journal-title":"J Urol"},{"issue":"7","key":"pone.0331142.ref022","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1089\/end.2015.0060","article-title":"Reoperation after holmium laser enucleation of the prostate for management of benign prostatic hyperplasia: assessment of risk factors with time to event analysis","volume":"29","author":"MA Elkoushy","year":"2015","journal-title":"J Endourol"},{"issue":"2","key":"pone.0331142.ref023","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4274\/jus.2015.103","article-title":"A rare complication of transurethral resection of the prostate: explosion of the bladder","volume":"2","author":"\u0130 Buldu","year":"2015","journal-title":"J Urol Surg"},{"issue":"4","key":"pone.0331142.ref024","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1016\/S0022-5347(17)67077-0","article-title":"Bladder explosions during transurethral surgery","volume":"114","author":"TC Ning","year":"1975","journal-title":"J Urol"},{"issue":"7","key":"pone.0331142.ref025","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-229580","article-title":"Intraperitoneal bladder explosion during transurethral 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Kwun-Chung","family":"Cheng","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,9,23]]},"references-count":26,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331142","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,23]]}}}