Presented by: Samit Sunny Roy MD, MSPH
Erlanger Health System

Introduction

As technologic advancement continues to improve in urology it is critical to evaluate objective outcomes after adoption to ensure appropriate value added to patients and clinicians. There are few studies examining the real-world results of adoption of the MOSES 120-watt holmium laser compared to prior laser models for ureteroscopic stone extraction (USE) with regards to operative time. We hypothesized that there would be a significant decrease in operative time for USE regardless of demographics or perioperative variables when using MOSES laser compared to prior models.

Materials

Medical records for all USE procedures (CPT 52356) in patients >18 years of age at a single academic tertiary referral center performed by a single endourologist between 2019-2022 were collected. Cases during which other procedures were performed concurrently were excluded. Demographic and perioperative data were abstracted from the medical record. Data was analyzed using Stata statistical software v16 using chi-square, t-tests, Wilcoxon rank-sum tests, and multivariable linear regression where appropriate.

Results

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A total of 238 USE cases were performed between 2019-2022. Of these, 53 (22.3%) were performed prior to adoption of the MOSES laser at our institution using 120W laser. There were no differences in patient sex (54 vs 64% female; p=0.14), BMI (31.0 vs 31.7; p=0.61), pre-stented patients (51% vs 57%; p=0.45), intraoperative stent placement (96 vs 95%; p=0.63), average Hounsfield units (911 vs 873; =0.47), maximum stone length (12 vs 13 mm; p=0.33), use of semirigid ureteroscope (89% vs 79%; p=0.13), or stone location (58% vs 46% renal; p=0.29). After adoption of MOSES laser there was a increase in average patient age (49 vs 54 years; p=0.030) as well as a decrease in average procedure time (60.3 vs 49.6 min; p=0.003). Multivariable linear regression modeling was performed to determine significant predictors of procedure time after controlling for relevant factors. Use of the MOSES laser (p=0.004), stone volume (p<0.001), and ureteral stone location (p=0.011) were the only significant predictors of procedure time after controlling for above listed variables.

Conclusion

There was a significant decrease in procedure time after adoption of the MOSES laser system even after controlling for demographic and perioperative factors.

Funding

N/A

Co-Authors

David Thompson, MD
Erlanger Health System

Jessica Lange, MD
Erlanger Health System