Abstract
BACKGROUND: Holmium Laser Enucleation of the Prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH). Pulse-modulated lasers, like MOSES technology (MoLEP), may enhance the procedure's efficiency and safety. METHODS: A 3-year single-center retrospective comparative study was conducted on 1368 patients treated with HoLEP/MoLEP at MITERA Hospital. RESULTS: A total of 688 patients were treated with HoLEP and 680 with MoLEP. Compared to HoLEP, MoLEP demonstrated shorter surgical (50.5 min [IQR 33-60] vs. 58 min [IQR 46-69], p < 0.01) and enucleation times (34 min [IQR 23-43] vs. 43 min [IQR 34-51], p < 0.001) and shorter hospital stay (8 h [IQR 6-19] vs. 12 h [IQR 9-24], p = 0.027), catheterization time (19 h [IQR 12-48] vs. 24 h [IQR 24-48], p < 0.001), and irrigation duration (5 h [IQR 2-8] vs. 7 h [IQR 3-10], p < 0.001), with similar morcellated tissue weight and morcellation time. At 1 month, MoLEP showed higher Qmax (27.3 mL/s [IQR 23.9-30.3] vs. 20 mL/s [IQR 17-23.6], p < 0.001), lower PVR (11.4 mL [IQR 7.7-15] vs. 12.5 mL [IQR 7-18], p = 0.005), better IPSS (4 [IQR 3-6] vs. 7 [IQR 5-11], p < 0.005), QoL (1 [IQR 1-2] vs. 2 [IQR 1-2], p < 0.001), lower PSA (1.8 ng/mL [IQR 1.1-2.6] vs. 2.4 ng/mL [IQR 1.3-3.5], p < 0.001), which were maintained at 6 months, and fewer Clavien-Dindo I (2.5% vs. 7.5%, p < 0.001) and II (16% vs. 25.7%, p < 0.001) complications. CONCLUSIONS: MoLEP offered significant advantages over HoLEP in this study.