MOSES TM Technology for Holmium Laser Enucleation of the Prostate: A Prospective Double-Blind Randomized Controlled Trial

No AccessJournal of UrologyAdult Urology1 Jul 2021MOSESTM Technology for Holmium Laser Enucleation of the Prostate: A Prospective Double-Blind Randomized Controlled Trial Nicholas L. Kavoussi, Naren Nimmagadda, Jennifer Robles, Connor Forbes, Alice Wang, Benjamin Stone, and Nicole L. Miller Nicholas L. KavoussiNicholas L. Kavoussi *Correspondence: Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, Tennessee 37212 telephone: 443-465-1485; FAX: 615-936-1590; E-mail Address: [email protected] Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Naren NimmagaddaNaren Nimmagadda Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Jennifer RoblesJennifer Robles Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Connor ForbesConnor Forbes Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Alice WangAlice Wang Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , Benjamin StoneBenjamin Stone Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee , and Nicole L. MillerNicole L. Miller Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee View All Author Informationhttps://doi.org/10.1097/JU.0000000000001693AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Holmium laser enucleation of the prostate has proven to be efficacious and safe for the treatment of benign prostatic hyperplasia. New laser technologies, such as the MOSES™ pulse laser system, improve energy delivery and may improve operative times. We sought to prospectively evaluate holmium laser enucleation of the prostate using MOSES technology in a double-blind randomized controlled trial. Materials and Methods: This is a single-center, prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to holmium laser enucleation of the prostate. Patients were randomized in a 1:1 fashion. The study was powered to evaluate for a difference in operative time. Secondary end points included enucleation, morcellation, and hemostasis times, as well as blood loss, functional outcomes and complications 6 weeks postoperatively. Results: A total of 60 patients were analyzed without difference in preoperative characteristics in either group (holmium laser enucleation of the prostate using MOSES technology: 30/60, 50%, holmium laser enucleation of the prostate: 30/60, 50%). Shorter total operative time was seen in the holmium laser enucleation of the prostate using MOSES technology group compared to the holmium laser enucleation of the prostate group (mean: 101 vs. 126 minutes, p <0.01). This difference remained significant on multiple linear regression. Additionally, the holmium laser enucleation of the prostate using MOSES technology group had shorter enucleation times (mean: 68 vs. 80 minutes, p=0.03), hemostasis time (mean: 18 vs. 29 minutes, 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 holmium laser enucleation of the prostate. There was no difference in functional or safety outcomes at followup. Conclusions: We report the results of a prospective, double-blind, randomized controlled trial comparing holmium laser enucleation of the prostate using MOSES technology to traditional holmium laser enucleation of the prostate. MOSES technology resulted in an improvement in operative time and a reduction in blood loss with comparable functional outcomes and complications compared to traditional holmium laser enucleation of the prostate. References 1. : The development of human benign prostatic hyperplasia with age. J Urol 1984; 132: 474. Link, Google Scholar 2. : Holmium laser enucleation of the prostate versus transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. J Endourol 2013; 27: 604. Google Scholar 3. : Holmium laser versus thulium laser enucleation of the prostate: a matched-pair analysis from two centers. Ther Adv Urol 2018; 10: 223. Google Scholar 4. : GreenLight laser (XPS) photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign prostatic hyperplasia: a randomized controlled study. J Urol 2015; 193: 927. Link, Google Scholar 5. : Clinical comparison of holmium laser enucleation of the prostate (HoLEP) and bipolar transurethral enucleation of the prostate (BTUEP) in patients under either anticoagulation or antiplatelet therapy. Eur Urol Suppl 2019; 181: e1924. Google Scholar 6. : Holmium laser enucleation of the prostate—outcomes independent of prostate size?J Urol 2008; 180: 2431. Link, Google Scholar 7. : Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center, prospective, randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol 2004; 172: 1926. Link, Google Scholar 8. : Experience with more than 1,000 holmium laser prostate enucleations for benign prostatic hyperplasia. J Urol 2010; 183: 1105. Link, Google Scholar 9. : Mind the gaps: adoption and underutilization of holmium laser enucleation of the prostate (HoLEP) in the United States from 2008-2014. J Endourol 2020; 34: 770. Google Scholar 10. : Learning curves and perioperative outcomes after endoscopic enucleation of the prostate: a comparison between GreenLight 532-nm and holmium lasers. World J Urol 2017; 35: 973. Google Scholar 11. : Comparative study of holmium laser enucleation of the prostate with MOSES enabled pulsed laser modulation. Urology 2020; 136: 196. Google Scholar 12. : MOSES technology in a stone simulator. Can Urol Assoc J 2018; 12: 127. Google Scholar 13. : Validation of the Clavien-Dindo grading system in urology by the European Association of Urology Guidelines ad hoc panel. Eur Urol Focus 2018; 4: 608. Google Scholar 14. : The MOSES holmium system—time is money. Can J Urol 2018; 25: 9313. Google Scholar 15. : Factors influencing intraoperative blood loss in patients undergoing holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia: a large multicenter analysis. Urology 2019; 132: 177. Google Scholar 16. : Holmium laser enucleation of the prostate: a size-independent new "gold standard". Urology, suppl., 2005; 66: 108. Google Scholar 17. : Bleeding after holmium laser enucleation of the prostate: lessons learned the hard way. BJU Int 2011; 107: 433. Google Scholar 18. : HoLEP has come of age. World J Urol 2015; 33: 487. Google Scholar 19. : What is MOSES effect: a historical perspective. J Endourol 2019; 33: 353. Google Scholar 20. : Advances in laser technology and fibre-optic delivery systems in lithotripsy. Nat Rev Urol 2018; 15: 563. Google Scholar Editor's Note: This article is the fourth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 179 and 180. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited By (2021) This Month in Adult UrologyJournal of Urology, VOL. 206, NO. 1, (1-2), Online publication date: 1-Jul-2021.Yuan Q, Wang S, Huang B, Xu Z, Li D, Li J, Fu W and Zhang X (2021) MOSES™ Technology for Holmium Laser Enucleation of the Prostate: A Prospective Double-Blind Randomized Control Trial. Letter.Journal of Urology, VOL. 206, NO. 3, (785-786), Online publication date: 1-Sep-2021. Volume 206Issue 1July 2021Page: 104-108 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.Keywordslasersprostatic hyperplasiasolid-stateMetricsAuthor Information Nicholas L. Kavoussi Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee *Correspondence: Department of Urology, Vanderbilt University Medical Center, 1211 Medical Center Dr., Nashville, Tennessee 37212 telephone: 443-465-1485; FAX: 615-936-1590; E-mail Address: [email protected] More articles by this author Naren Nimmagadda Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Jennifer Robles Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Connor Forbes Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Alice Wang Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Benjamin Stone Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Nicole L. Miller Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee Financial and/or other relationship with Boston Scientific Corporation, Karl Sturz Endoscopy, Intuitive Surgical, and Virtuoso Surgical. More articles by this author Expand All Editor's Note: This article is the fourth of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 179 and 180. Advertisement Loading ...