MOSESTM Technology for Holmium Laser Enucleation of the Prostate: A Prospective Double-Blind Randomized Control Trial.

Holmium laser enucleation of the prostate (HoLEP) has proven to be efficacious and safe for the treatment of benign prostatic hyperplasia (BPH). New laser technologies, such as the MOSES™ Pulse laser system, improve energy delivery and may improve operative times. We sought to prospectively evaluate HoLEP using MOSES™ technology (M-HoLEP) in a double-blind randomized controlled trial.

This is a single-center, prospective, double-blind, randomized controlled trial comparing M-HoLEP to HoLEP. Patients were randomized in a 1:1 fashion. The study was powered to evaluate for a difference in operative time. Secondary endpoints included enucleation, morcellation, and hemostasis times, as well as blood loss, functional outcomes and complications 6 weeks post-operatively.

A total of 60 patients were analyzed without difference in preoperative characteristics in either group (M-HoLEP:30/60, 50%, HoLEP: 30/60, 50%). Shorter total operative time was seen in the M-HoLEP group compared to the HOLEP group (mean:101 vs. 126min, p <0.01). This difference remained significant on multiple linear regression. Additionally, the M-HoLEP group had shorter enucleation times (mean:68 vs.80min, p=0.03), hemostasis time (mean:18 vs. 29min, p <0.01), and less blood loss (mean:-6.3 vs.-9.0%, p=0.03), measured by a smaller change in hematocrit postoperatively, compared to the traditional HoLEP. There was no difference in functional or safety outcomes at follow-up.

We report the results of a prospective, double-blind, randomized controlled trial comparing M-HoLEP to traditional HoLEP. MOSES™ technology resulted in an improvement in operative time and a reduction in blood loss with comparable functional outcomes and complications compared to traditional HoLEP.

The Journal of urology. 2021 Feb 22 [Epub ahead of print]

Nicholas L Kavoussi, Naren Nimmagadda, Jennifer Robles, Connor Forbes, Alice Wang, Benjamin Stone, Nicole L Miller

Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.

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