The recommendations on carrying out a multiparametric magnetic resonance imaging (mpMRI) for the primary diagnostics and during active surveillance of prostate cancer, include as a consequence an image-guided sampling from conspicuous areas. In doing so, the information on the localization provided by mpMRI is used for a targeted biopsy of the area suspected of being a tumor. The targeted sampling is mainly performed under sonographic control and after fusion of MRI and ultrasound but can also be (mostly in special cases) carried out directly in the MRI scanner. In an ultrasound-guided biopsy, it is vital to coregister the MR images with the ultrasound images (segmentation of the contour of the prostate and registration of suspect findings). This coregistration can either be carried out cognitively (transfer by the person performing the biopsy alone) or software based. Each method shows specific advantages and disadvantages in the prioritization between diagnostic accuracy and resource expenditure.

Background En bloc tumor resection of bladder tumors (ERBT) is a novel alternative procedure to conventional resection of bladder tumor (cTURBT), which might help to address common problems of the standard method, such as inadequate detrusor muscle in specimens, high re-resection rates and high recurrence rates. Objective To analyze current data on ERBT in efficacy and safety compared to cTURBT. Data sources: PubMed. Study selection Two independent authors identified trials based on keywords and inclusion criteria. A third author was consulted in case of discrepancies. Screening keywords: ERBT, en bloc transurethral resection of bladder tumor, TURBT en bloc. A meta-analysis of 13 studies was performed. The effect size was estimated based on odds ratios and mean differences including their corresponding two-sided 95% confidence intervals. Data synthesis The analyzed studies comprised a homogenous collective in terms of tumor size, tumor multiplicity and tumor stage. Operation time did not significantly differ between the methods. Differences were observed in hospitalization and catheterization time in favor of ERBT. Reported complications did not show clear differences. There was significantly more detrusor muscle in the specimens in the ERBT group. No significant differences were found in recurrence up to 2 years of follow-up. Conclusion ERBT is a safe alternative to conventional TURBT with promising features regarding effective resection of detrusor muscle. More standardized data on recurrence rates, different resection modalities and resection margin results are needed.

Zusammenfassung Hintergrund Die transurethrale En-bloc-Resektion von Blasentumoren (ERBT) ist eine Alternative zur konventionellen transurethralen Resektion von Blasentumoren (TURB). Sie könnte dazu beitragen bekannte Probleme der Standardmethode wie fehlenden Detrusormuskel im Präparat, hohe Nachresektions- sowie Rezidivraten zu verbessern. Ziel Die Analyse der aktuellen Datenlage zur ERBT in Bezug auf Effektivität und Sicherheit im Vergleicht zur TURB. Datenquelle: PubMed. Methode Zwei unabhängige Autoren identifizierten Studien basierend auf den Einschlusskriterien sowie den Schlüsselwörtern. Ein dritter Autor wurde bei Unstimmigkeiten zur Entscheidungsfindung involviert. Screening Keywords: ERBT, en bloc transurethral resection of bladder tumor, en bloc TURBT. Eine Metaanalyse von 13 Studien wurde durchgeführt. Effektgrößen wurden mittels Odds Ratios und mittleren Differenzen samt den zugehörigen zweiseitigen 95 %-Konfidenzintervallen geschätzt. Ergebnisse Die behandelten Studien untersuchten ein homogenes Kollektiv in Bezug auf Tumorgröße, Multiplizität und Stadium. Die Operationszeit zeigte sich nicht signifikant verschieden zwischen den Methoden. Signifikante Unterschiede bestanden in Hospitalisierungs- und Kathetereinliegedauer zugunsten der ERBT. Die Daten in Bezug auf Komplikationsraten zeigen keine sicheren Unterschiede auf. In der ERBT-Gruppe konnte signifikant mehr Detrusormuskel im Präparat nachgewiesen werden. Keine Unterschiede ergaben sich in der Rezidivrate bei einem Follow-up bis 2 Jahre. Schlussfolgerung Die ERBT ist eine sichere Alternative zur konventionellen TURB mit vielversprechenden Möglichkeiten bezüglich der effektiven Resektion von Detrusormuskulatur. Mehr Daten aus randomisierten kontrollierten Studien zu Rezidivraten, unterschiedlichen Energiequellen und Resektionstechniken sowie freien Resektionsrändern sind notwendig um den Stellenwert der Methode klar einzuordnen.

BACKGROUND/AIM:Exctracapsular extension (ECE) in prostate cancer has a high impact on treatment decision. MRI might predict presence of ECE non-invasively.PATIENTS AND METHODS:Triplanar T2w-sequences, DWI (diffusion weighted imaging) and DCE (dynamic contrast-enhanced imaging) of 34 patients with PCa were analyzed to prior prostatectomy. Sensitivity (SS) and specificity (SP) of T2w, apparent diffusion coefficient (ADC), plasma flow (PF) and mean transit time (MTT) normalized by PCa/normal tissue ratio for prediction of CI (capsular infiltration)/ECE were determined by area-under-the-receiver-operating-characteristics analysis.RESULTS:SS/SP for detecting ECE was 29/85. AUC (area under the curve) of ECE cases was 0.98/0.92/0.69 (cut-off-ratios 3.2/0.51/0.46), SS 93/100/86% and SP 95/80/50% for PF-/MTT-/ADC-ratios, respectively. PF- and MTT-ratios between CI and without CI/ECE differed significantly (PF, p<0.0001; MTT, p=0.0134) with SS/SP 84/89% for PF and SS/SP 52/100% for MTT-ratios. No significant differences regarding ADC-ratios were identified.CONCLUSION:ECE/CI can be assessed by quantitative DCE analysis with great diagnostic confidence and higher specificity than ADC.

Interventional treatment of stones essentially consists of three treatment modalities. Extracorporeal shockwave lithotripsy (ESWL), in addition to uterorenoscopy (URS) and percutaneous nephrolitholapaxy (PCNL) is an essential treatment pillar and is the only noninvasive therapy option for the treatment of urinary stones. After a long period of ESWL being the leading choice in stone treatment, the number of SWL interventions diminished in recent years in favor of the other two treatment modalities (URS and PCNL). This article describes the indications, surgical technique and management of complications of SWL.

Correct positioning of patients during preoperative preparations is essential for success of the intervention to avoid any positioning trauma and to provide the best access to the targeted structures. The appropriate positioning (and optimal performance) means that complications are avoided and also makes an essential contribution to the smooth course of the surgical intervention. A correct position is essential particularly in urology because the organs assigned to the discipline of urology are anatomically mostly difficult to reach. A further important function of the correct positioning technique is the avoidance of injuries to the patient. This article summarizes the most common positioning techniques in urological interventions with special emphasis on the explanation of practical advice, helpful tips and possible complications that can enable even junior surgeons to correctly perform the appropriate positioning technique.

ObjectivesTo examine the benefit of drain placement during open partial nephrectomy.MethodsOverall, 106 patients treated with open partial nephrectomy were enrolled in a prospective randomized trial. Based on the randomization, a drain was placed or omitted. Complications were assessed according to the Clavien classification. Pain level and requirement for analgesics was evaluated according to a customized pattern.ResultsThere was no significant difference in the two groups regarding age, body mass index, American Society of Anesthesiologists score, tumor size and nephrometry (preoperative aspects and dimensions used for an anatomical classification). In terms of overall and drain‐related complications, no advantage of placing a drain could be proven (P = 0.249). Patients with a drain suffered from a significantly higher pain level (P = 0.01) and showed prolonged mobilization (P < 0.001). There was no difference in bowel movements and requirement of additional analgesics (P = 0.347 and 0.11).ConclusionsThe results of the study suggest that drain placement during open partial nephrectomy can safely be omitted, even in cases with violation of the collecting system.

OBJECTIVE:Despite the low local toxicity of the used agents, Cisplatin-based chemotherapy (CBP) for patients with testicular germ cell tumors (TGCT) is mostly delivered via a central venous access (CVA). Since 2008, CBP is given peripherally in our hospital.METHODS:Medical reports of TGCT patients who received CBP between September 1991 and August 2014 were evaluated. Complications regarding the way of administration (CVA vs. peripheral venous catheter [PVC]) were classified according to the Common Terminology Criteria of Adverse Events. The complication rates were compared using chi square test and propensity score matching.RESULTS:During 288 cycles in 109 patients, 85 complications (29.5%) were observed with similar rates for overall (PVC 31.3%, CVA 29.9%; p = 0.820) and grade I complications (21.3%, 25.4%; p = 0.470). More grade II complications were observed in the PVC group (10.0 vs. 1.5%; p < 0.001). Grade III complications requiring invasive treatment were found only in the CVA group (3.0%; p = 0.120). Using propensity score matching, no differences in overall (p = 0.950), grade I (p = 0.540) and grades II/III (p = 0.590) complications were seen.CONCLUSION:The peripheral and central administration of CBP has similar overall complication rates. Despite more grade II complications, the peripheral administration of CBP is a safe alternative for TGCT patients. Additionally, no severe grade III complications occurred.

Objectives: This study evaluates the feasibility and safety of open-partial nephrectomies in the ZIRK-technique (Zero Ischemia Resection in the Kidney) for renal masses with high-risk anatomical features - objectified by the PADUA score. Methods: We identified 40 consecutive cases of partial nephrectomies performed without clamping of the renal artery in our department of urology. Retrospective analysis of the preoperative CT or MRI scans showed 27 cases with a PADUA score ≥8, of which 15 cases had a score ≥10. Cases were in particular assessed regarding operation time (ORT), estimated blood loss (EBL), surgical margins and postoperative complications using the Clavien classification. Results: The mean age of the study population was 67.6 years with an average BMI of 26.8 kg/m2. The mean ORT was 1:46 with an average EBL of 521 ml. Clavien grade II complications were observed seven times, while 3 patients had a grade IIIa complication. Despite complex and adverse location of the tumors, nephron-sparing surgery without ischemia could be performed with negative surgical margins for all cases. EBL, transfusion rate and complication were considerably more frequent in high-risk tumors. Conclusion: Highly complex renal tumors, PADUA ≥10, can be resected in ZIRK-technique with good operative outcome and a low complication rate.

Objectives: To evaluate the role of lymph vessel density (LVD) and lymphangiogenesis in nonseminomatous testicular germ cell tumors (NSGCT) using the specific lymphatic endothelial cell (LEC) marker LYVE-1.Materials and methods: NSGCT specimens of 77 patients (32 with and 45 without metastases) were stained immunohistochemically using a:LYVE-1 antibody. LVD was measured in different representative areas by the standardized "hot spot" method. Fluorescence double staining for LYVE-1 and Ki-67 were performed. The median follow-up period was 46 (range 3-170) months.Results: The mean peritumoral (2.16 +/- 2.17) and nontumoral LVD (3.17 +/- 3.24) were significantly higher than intratumoral LVD (0.16 +/- 0.73) (both: P = < 0.001). In 5 patients proliferating LECs were observed. The peritumoral LVD was 2.66 (+/- 2.31) and 1.80 (+/- 2.02) in metastatic and nonmetastatic NSGCT, respectively. A higher peritumoral LVD was associated with the presence of metastases at the time of diagnosis (P = 0.087). The mean peritumoral LVD in tumors with and without lymphovascular invasion (LVI) was 3.33 (+/- 2.20) and 1.62 (+/- 1.95), respectively (P < 0.001). The presence of LVI detected by LYVE-1 (LVI-LYVE-1) was independently associated with metastatic disease (logistic regression; P = 0.045).Conclusions: The presence of a high peritumoral LVD and LVI-LYVE-1 are both associated with metastatic disease in NSGCT. LVI-LYVE-1 was independently associated with the presence of metastases at the time of diagnosis. Proliferating LECs are present, suggesting that lymphangiogenesis may promote metastatic dissemination of tumor cells in NSGCT. (C) 2014 Elsevier Inc. All rights reserved.

Purpose: We separately evaluated the lymphatic and blood vascular systems to assess the diagnostic accuracy of microvascular invasion and identify predictive markers for occult metastasis of testicular nonseminomatous germ cell tumors.Materials and Methods: Tissue samples of 86 patients treated for testicular nonseminomatous germ cell tumors (stage 1 in 48 and stage greater than 1 in 38) were stained using the lymphatic endothelial cell specific marker LYVE-1 and the blood vessel endothelial cell marker von Willebrand factor. We assessed lymph vessel density in LYVE-1 stained sections and blood vessel density in von Willebrand factor stained sections. Lymphovascular invasion in LYVE-1 stained sections and blood vascular invasion in von Willebrand factor stained sections were documented. Parameters were correlated with standard clinicopathological data.Results: Blood vessel density in von Willebrand factor sections was significantly greater than lymphatic vessel density in LYVE-1 sections (p < 0.001). Peritumor and nontumor lymphatic vessel density in LYVE-1 sections was associated with metastasis at diagnosis (OR 1.277/U, p = 0.020 and OR 1.113/U, p = 0.095). Lymphovascular invasion in LYVE-1 sections was significantly associated with metastasis (OR = 4.517, p = 0.002) but blood vascular invasion in von Willebrand factor sections was only slightly significant (OR 2.261, p = 0.071). Only lymphovascular invasion in LYVE-1 stained sections was significantly associated with metastasis in a multiple logistic regression model. Microvascular invasion in hematoxylin and eosin stained sections was not associated with metastasis but microvascular invasion evaluated in LYVE-1 and von Willebrand factor stained sections was associated with metastasis (OR 3.506, p = 0.016).Conclusions: Lymphovascular invasion in LYVE-1 stained sections was the most important predictive parameter for metastasis at diagnosis, suggesting greater relevance of the lymphatic system in metastatic dissemination of testicular nonseminomatous germ cell tumors. Vascular endothelial cell specific markers provide higher diagnostic accuracy for microvascular invasion. Our results may impact the current concept of microvascular invasion used for risk stratification of clinical stage 1 testicular nonseminomatous germ cell tumors.

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy and New Technology (III)1 Apr 20132177 LEARNING CURVE IN THULIUM ENUCLEATION OF THE PROSTATE Patrick Krombach, Manuel Ritter, and Axel Häcker Patrick KrombachPatrick Krombach Mannheim, Germany More articles by this author , Manuel RitterManuel Ritter Mannheim, Germany More articles by this author , and Axel HäckerAxel Häcker Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2086AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Thulium laser enucleation of the prostate employs the same technical steps as holmium laserenucleation of the prostate. the learning curve for HoLEP is reported to be around 50 cases. The thulium laser offers the possibility to vaporize tissue. In the very beginning of the learning curve this presumably results in a higher vaporization gradient (Joules used/gram resected tissue). To evaluate the learning curve of thulium laserenucleation of the prostate, the intraoperative date from a single novice surgeon was analyzed retrospectively. METHODS Intraoperative data from the first 105 consecutive cases of thulium Laserenucleation (Revolix®, Lisa Laser, Germany) and subsequent morcellation (Piranha®, Richard Wolf, Germany) were analyzed. For all procedures an experienced surgeon was present for back-up. The novice surgeon had no TUR-experience, he assisted in approximately 50 cases prior to his own procedures. Total OR-time (min.), laser time (min.), praeoperative TRUS volumetry (g), histology weight (g) and laser energy delivered (Joule) were assessed. The median values of consecutive groups of 10 cases were compared: gram/OR time, gram/laser time, Joule/gram. RESULTS As shown in the graphics, the amount of resected tissue per total OR-time increases. After the first 50 procedures the values increased from less than 0,6g/min to more than 0,6g/min. A steady curve for the vaporization gradient seems to appear after 50 cases. This reflects more uniform movements of the surgeon within the surgical layers. Intraoperative bleedings which required vaporisation appeared constantly without notable relation to the learning curve. CONCLUSIONS A novice surgeon needs approx. 50 cases to develop stable enucleation skills with the thulium laser. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e893 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Metrics Author Information Patrick Krombach Mannheim, Germany More articles by this author Manuel Ritter Mannheim, Germany More articles by this author Axel Häcker Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PURPOSE To assess the changing presentation and treatment of nonseminomatous testicular germ cell tumors (NSGCT) and to investigate predictive factors for the status of metastasis at diagnosis and on relapse and death. MATERIALS AND METHODS Retrospective record review of 147 patients that underwent inguinal orchiectomy from 1987-2007. Follow-up data was available for 102 patients (median follow-up: 80 months (0-243); 96 patients alive). RESULTS Mean patients age increased (p = 0.015) and more patients were diagnosed in clinical stage I (CSI) (p = 0.040). The fraction of yolk sac (YS) elements inclined (p = 0.030) and pT2 tumors increased (p < 0.001). Retroperitoneal lymph node dissection (RPLND) declined whereas more patients were treated with chemotherapy (p < 0.001; p = 0.004). There was an increase in relapse free (RFS) and cancer specific survival (CSS) due to an improvement in patients with disseminated disease (p = 0.014; p < 0.001). The presence of YS and teratoma elements showed a reduction in the odds ratio (OR) for metastasis at diagnosis (p = 0.002, OR: 0.262; p = 0.009, OR: 0.428) whereas higher pT-stage was associated to their presence (p = 0.039). Patients with disseminated disease (CS > I) showed a declined CSS compared to CSI patients (p = 0.055). The presence of YS elements was associated to an improved RFS (p = 0.038). CONCLUSIONS In our single institution study the face of NSGCT markedly changed over 20 years even after the introduction of Cisplatin-based chemotherapy. These changes were accompanied by an improvement in RFS and CSS. When dealing with NSGCT patients such observations now and in the future should be taken into account.

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2012919 LYMPHANGIOGENESIS IN NON SEMINOMATOUS TESTICULAR CANCER AND ITS ASSOCIATION TO THE STATUS OF METASTASIS AT DIAGNOSIS Julia Heinzelbecker, Tobias Gropp, Christel Weiß, Katrin Hüttl, Annette Steidler, Axel Haecker, Christian Bolenz, and Lutz Trojan Julia HeinzelbeckerJulia Heinzelbecker Mannheim, Germany More articles by this author , Tobias GroppTobias Gropp Mannheim, Germany More articles by this author , Christel WeißChristel Weiß Mannheim, Germany More articles by this author , Katrin HüttlKatrin Hüttl Mannheim, Germany More articles by this author , Annette SteidlerAnnette Steidler Mannheim, Germany More articles by this author , Axel HaeckerAxel Haecker Mannheim, Germany More articles by this author , Christian BolenzChristian Bolenz Mannheim, Germany More articles by this author , and Lutz TrojanLutz Trojan Mannheim, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1016AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the role of lymph vessel density (LVD) and lymphangiogenesis in nonseminomatous testicular germ cell tumors (NSGCT) using the specific lymphatic endothelial cell (LEC) marker LYVE-1. METHODS Paraffin embedded tumor samples from 77 patients (clinical stage 1: n=45; metastatic disease: n=32) were stained with the LEC marker LYVE-1. LVD was assessed in different areas using a standardised method. Proliferating LECs were detected using fluorescence double immunostaining of LYVE-1 and Ki67 in a subgroup of 50 patients. The presence of lymphatic vascular invasion (LVI) was documented. The parameters were correlated with clinico-pathological data. Median follow-up was 46 (range: 3 – 170) months. RESULTS Peritumoral lymph vessels were identified in 57 patients (74.0%; mean LVD: 2.16 (±2.17)), intratumoral lymph vessels in 11 patients (14.3%; mean LVD: 0.16 (± 0.73)) and nontumoral lymph vesssels in 56 patients (81.2%; mean LVD: 3.17 (±3.24)). Higher peritumoral LVD was associated with the presence of metastatic disease at diagnosis (p= 0.0824). In five patients (10%) proliferating lymphatic vessels were present. Four of these patients had metastatic disease at diagnosis. None of these patients relapsed nor died. Altogether four patients relapsed and four patients died one of them due to relapse of the disease. In three of the four patients who died peritumoral lymph vessels were present with a mean LVD of 3.88 (± 2.99). Lymphvascular invasion was found in 24 patients (31.2%). The presence of LVI was significantly associated with metastatic disease at the time of diagnosis (p= 0.0121). LVI was significantly more frequent in tumours with a high peritumoral LVD (p= 0.0005). CONCLUSIONS For the first time we evaluated LVD in NSGCT. Our findings show an association of LVD with metastatic disease at diagnosis. The existence of proliferating lymphatic vessels indicates that lymphangiogenesis may play a role in the dissemination of NSGCT. LVI was associated with metastasis at the time of diagnosis. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e374-e375 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Julia Heinzelbecker Mannheim, Germany More articles by this author Tobias Gropp Mannheim, Germany More articles by this author Christel Weiß Mannheim, Germany More articles by this author Katrin Hüttl Mannheim, Germany More articles by this author Annette Steidler Mannheim, Germany More articles by this author Axel Haecker Mannheim, Germany More articles by this author Christian Bolenz Mannheim, Germany More articles by this author Lutz Trojan Mannheim, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The objective of this study was to assess the functional efficacy of newly developed antirefluxive ureter stents (DJ), by performing immediate post-stenting cystograms on patients with acute ureteral obstruction requiring a DJ stent, and assessing stent-related symptoms by means of ureteral stent symptoms questionnaire (USSQ). Patients with acute hydronephrosis requiring internal drainage were randomized to receive either an antirefluxive DJ or a conventional DJ (7 Fr., 26 cm, polyurethane, Urovision ® , Germany). Mean stone size was 6.64 ± 3.33 and 6.5 ± 3.54 mm. Immediately after correct placement of the DJ, 200 ml of diluted contrast media was introduced into the bladder under fluoroscopic control to detect vesicoureteral reflux (VUR). Patients completed German versions of the USSQ on days 2 and 7 following stent placement, and 1 week after stent removal. The results were analyzed. 13 conventional and 16 antirefluxive stents were placed in 29 patients. Reflux was documented in eight conventionally stented patients (62.5%). Two of the 16 patients with antirefluxive stents (22%) presented reflux. 1 week after stent implantation, the mean pain value was 1.1 in the antirefluxive group and 3 in the standard group ( p < 0.062). Flank pain during micturition occurred after 2 days in seven patients (58%) with standard stents and in three patients (33%) with antirefluxive stents ( p < 0.23). 1 week after stent insertion, flank pain had dropped to 40% in the standard group and 11% in the antirefluxive group ( p < 0.3). Our initial experience showed that the antirefluxive system might be effective in terms of reflux prevention and reduction of stent related symptoms especially during sexual intercourse.

Background and Purpose: Transurethral laser enucleation of the prostate is a common therapeutic option for the treatment of benign prostate enlargement. Evacuation of the enucleated tissue from the bladder is usually performed by electric morcellators. Until now, a standardized evaluation of the different morcellator settings does not exist. Therefore, we developed an ex-vivo model to find the best settings for four different morcellators.Materials and Methods: We morcellated pieces of a prostate adenoma after an open adenomectomy. The same speed settings were used to morcellate commercially available minced meat, fine pork sausage meat, and bovine heart, all of which had been cooked for 10 minutes using a Piranha Morcellator. We also morcellated raw pig perirenal fat tissue, raw pig liver, and raw bovine heart. The pieces were morcellated at different speed settings in an open water tank filled with saline. Because raw bovine heart showed to be the most equivalent tissue, we morcellated five pieces with four different settings of four different morcellators: The Piranha, the VersaCut, and two morcellator prototypes.Results: The median retrieval rate for the prostate adenoma was 14.02 (3.7-19.8) g/min. The retrieval rate for raw bovine heart was 13.75 (5.66-20) g/min. The maximum morcellation rates of the morcellators were: Piranha 20 (19.3-21.4) g/min, VersaCut 10.8 (8.2-13.1) g/min, Karl Storz prototype 9.8 (7.9-10.76) g/min, and Richard Wolf prototype 38.6 (35.3-42.9) g/min.Conclusion: Raw bovine heart tissue is suitable for ex-vivo testing of prostate morcellators and can replace human prostate tissue in this standardized setting. In our ex-vivo study, the morcellation rates of the different morcellators increased with optimized oscillation speed and suction power settings. This needs to be confirmed in clinical studies.