Is New Always Better? Comparing the Piranha© and Multicut© Morcellators During Endoscopic Enucleation of the Prostate: A Prospective Randomized Trial.

Introduction: The main objective of the study was to demonstrate the noninferiority of the morcellation efficiency (ME) of the Multicut^© morcellator compared with the Piranha^© morcellator following anatomical endoscopic enucleation of the prostate (AEEP). Patients and Methods: The present study is a prospective, randomized, controlled, and single-center trial. Patients with an indication for obstructive prostate surgery via AEEP were prospectively included in the study. To assess ME, the time in minutes required for morcellation was recorded and divided by the weight in grams of morcellated prostatic tissue obtained from the pathology report. A comparative analysis of ME was also performed between cases with >60 g and <60 g of morcellated tissue. Results: A total of 137 patients were included, 68 in the Multicut group and 69 in the Piranha group. The average ME was higher in the Piranha group, with 9.33 g/minute compared with 7.34 g/minute in the Multicut group (p = 0.012). When analyzing cases with ≤60 g of morcellated tissue, the MEs were 7.32 g/minute for Multicut and 11.31 g/minute for Piranha (p = 0.004). For cases with >60 g of tissue, the efficiencies were 7.4 g/minute and 8.0 g/minute (p = 0.220), respectively. The incidence of beach balls was slightly higher in the Multicut group than in the Piranha group, 14.7% vs 7.2% (p = 0.261). We observed a 4.4% and 0% incidence of bladder mucosa injury with the Multicut and Piranha, respectively. Conclusions: In terms of ME, the Multicut is inferior to the Piranha. This difference appears to be more pronounced in smaller prostates. It seems that the Piranha might experience more malfunctions, whereas the Multicut might be associated with more bladder injuries and might require more auxiliary procedures to complete the retrieval of the prostatic tissue.