Moses laser enucleation of the prostate (MoLEP)

Variations in both surgical technique as well as important laser and morcellator technologic advancements have improved prostate enucleation treatment for benign prostatic hyperplasia (BPH) over the past decade. In this manuscript we highlight how Moses laser enucleation of the prostate (MoLEP) using novel laser technology has improved hemostasis and facilitated transitioning to same day catheter removal and same day discharge for many patients. MoLEP utilizes Moses™ 2.0 BPH mode (Lumenis) pulsed modulated technology, which allows for simultaneous coagulation and dissection resulting in a highly efficient enucleation. MoLEP adapts previously described historical HoLEP techniques by moving away from predominately peeling (blunt resectoscope dissection) towards increased non-tissue contact lasering with Moses bubble dissection. MoLEP has shown reduced fiber tip break back and intraoperative case interruptions to re-strip the fiber along with facilitated transition of many patients to same day catheter removal and same day discharge, including very large gland prostates (≥175 mL) and patients undergoing concurrent surgeries at the time of prostate enucleation. We highlight a select case of successful same day trial of void and same day discharge for a patient with a 50 mL prostate on active anticoagulation (Apixiban). MoLEP supports well described prostate enucleation outcomes, while improving hemostasis and safely transitioning many patients toward same day trial of void and same day discharge.