Continuous Intravesical Pressure Monitoring Using a Handheld Pressure Meter During Prostatic Morcellation: A Feasibility Pilot Study

Abstract

Introduction:

Adequate bladder distention is critical for safe and efficient transurethral morcellation during endoscopic prostate enucleation. Traditional assessment methods are subjective and may compromise safety and efficiency. We evaluated the feasibility and impact of continuous intravesical pressure (IVP) monitoring using a handheld pressure meter during morcellation compared with conventional manual bladder assessment.

Material and Methods:

In this prospective, randomized pilot study, 30 patients undergoing transurethral morcellation after bipolar prostate enucleation were randomized 1:1 to continuous IVP monitoring with a handheld pressure meter (Group A) or manual suprapubic bladder assessment by a urology fellow (Group B). In Group A, morcellation was performed while IVP remained within a predefined safe range (15–60 mmHg), with pauses for pressure correction as needed. The primary outcome was the number of morcellation pauses. Secondary outcomes included morcellation time, morcellation efficiency (g/min), total operative time, hemoglobin deficit, complications, and functional outcomes (International Prostate Symptom Score, maximum urinary flow rate, and post-void residual) at 3 and 6 months.

Results:

Baseline characteristics were comparable between groups. Morcellation time was significantly shorter in Group A (8.9 ± 3.7 vs 13.3 ± 2.1 minutes; p = 0.0008), with fewer morcellation pauses (3.3 ± 0.7 vs 5.7 ± 1.2; p < 0.0001) and higher morcellation efficiency (9.9 ± 2.0 vs 5.9 ± 0.6 g/min; p < 0.0001). Enucleation time, total operative time, tissue weight, and hemoglobin deficit were similar. No bladder injuries or postoperative fever occurred. Functional outcomes at 3 and 6 months were comparable.

Conclusion:

Continuous IVP monitoring using a handheld pressure meter during transurethral morcellation is feasible, reduces interruptions, and significantly improves morcellation efficiency without compromising safety or functional outcomes. This inexpensive technique may be a valuable safety adjunct, particularly for less experienced surgeons, and merits evaluation in larger randomized trials.