Presented by: Jonas Herrmann MD
University Medical Centre Mannheim

Introduction

Holmium laser enucleation of the prostate (HoLEP) is an established surgical option in the treatment of benign prostatic hyperplasia regardless of the prostate volume. Pulse modulation, such as Moses Technology, has recently been introduced and may offer potential advantages in HoLEP. The purpose of this study was to compare the clinical safety and efficacy of MOSES laser enucleation of the prostate (MoLEP) to HoLEP with a conventional pulse setting in a tertiary center.

Materials

Perioperative data from 117 patients who underwent MoLEP performed by an experienced endoscopic surgeon at our institution from 2021 to 2023 was prospectively collected in our database. Propensity score matching using prostate volume, patient age, body mass index (BMI), and anticoagulant intake was performed using a database of 237 patients treated by HoLEP by the same surgeon during the same period. In total, 234 patients were included in this study. 30-day complications were recorded and graded according to the Clavien-Dindo Classification (CDC), and the Comprehensive Complication Index (CCI).

Results

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Preoperative parameters were similar between groups, with a mean prostate volume of 104 ml (MoLEP) vs. 102 ml (HoLEP), age (70 vs. 71 years), BMI (27 vs. 27), and intake of anticoagulants (34% vs. 35%). All cases were performed using the EnBlock technique with early apical release. Overall, there was no significant difference in mean operation time (61.5 vs. 58.1 min, p = 0.42), enucleation efficiency (2.5 vs. 2.6 g/min, p = 0.74), hemoglobin drop (0.9 vs.  0.7 mg/dl, p = 0.48), and hemostasis time (7.8 vs. 8 min, p = 0.75). Complication rates were very low in both groups (16.2% in HoLEP and 17.1% in MoLEP). No differences were noted in both CDC (p = 0.63) and CCI (p = 0.24). The rate of relevant complications > CDC IIIa was 0.9% in HoLEP (1 case of endoscopic clot evacuation and bipolar coagulation) and 1.7% in MoLEP (2 cases of endoscopic coagulation due to bleeding). No transfusions were administered in either group.

Conclusion

In this series, there were no significant differences in perioperative parameters such as procedure time, enucleation time, hemostasis time or blood loss. Further, there were no differences in complication rates graded by the CDC or CCI. Overall, enucleation efficiency was high in both groups and the procedure time was short. HoLEP is an extremely efficient and safe treatment option in experienced hands, regardless of the use of pulse modulation technology.

Funding

No funding was received.

Lead Authors

Friedrich O Hartung, MD
University Medical Centre Mannheim

Co-Authors

Maren J Wenk, MD
University Medical Centre Mannheim

Britta Grüne, MD
University Medical Centre Mannheim

Luisa Egen, MD
University Medical Centre Mannheim

Maurice S Michel, Prof. Dr.
University Medical Centre Mannheim