Presented by: Victoria Jahrreiss MD
University Hospital Southampton NHS Trust, Southampton, UK; Department of Urology Medical University Vienna, Austria

Introduction

In-vitro studies have shown that the holmium MOSES technology can lead to an increase of efficacy in lithotripsy and a reduction of retropulsion, but clinical evidence comparing it to Non-MOSES technology is still scarce. We did a comparison of ureteoroscopy and laser stone fragmentation (URSL) between Holmium:YAG laser with MOSES vs Non-MOSES technology.  

Materials

Patient data and outcomes were prospectively collected and analyzed regarding patient demographics, stone parameters and clinical outcomes. Patients undergoing URSL with standard high power holmium laser (100W) without MOSES technology (group-1) were compared to 60W holmium laser with MOSES (group-2) using the same clinical laser settings (0.4-1J, 20-40Hz) with dusting and pop-dusting technique. The independent t-test, Mann–Whitney-U test and Chi-squared test were used, with a p-value of <0.05 as significant. Given the different size of the cohorts, we performed a propensity score 1:1 matched analysis.

Results

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A total of 206 patients (1:1 matched) with a male:female ratio of 94:112 and a median age of 56 (range: 39-68) years were analyzed. Group 1 and 2 were matched for ureteric stones (27.7% and 22.3%, p=0.42), pre-stenting (37% and 35%, p=0.66), mean number of stones (1.76±1.3) and 1.82±1.4,p=0.73) and ureteral access sheath (37% and 35%,p=0.77) respectively.

While there was no significant difference in clinical outcomes, the stone size was slightly larger in group 2, 14.8mm±10.8 vs 11.7mm± 8.0, for a lower operative time 42.7min± 30.6 vs 48.5min± 25, lower perioperative complication rates 3.9% vs 4.9% and a higher stone free rate 90.3% vs 87.4%.

Conclusion

While the use of MOSES technology was slightly beneficial for treatment of stones in terms of clinical outcomes, this was not statistically significant. As this debate continues, there is a need for high quality randomized studies to show if there is a true difference in these outcomes.

Funding

None.

Co-Authors

Francesco Ripa, MD
Department of Stones and Endourology, University College London Hospitals

Clara Cerrato, MD
University Hospital Southampton NHS Trust

Carlotta Nedbal, MD
University Hospital Southampton NHS Trust, Università Politecnica delle Marche, Ancona, Italy

Amelia Pietropaolo, MD
University Hospital Southampton NHS Trust

Bhaskar Somani, Prof
University Hospital Southampton NHS Trust