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.