V02-11: Holmium laser enucleation of the prostate using Moses technology in treating benign prostate hyperplasia
Holmium laser enucleation of the prostate (HoLEP) is the most efficient and durable minimally invasive technique in treating men with lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH) independent of prostate size. The Lumenis PulseTM 120 Holmium laser system, using Moses technology, was developed to optimize energy delivery through water to the target tissue. Ex-vivo studies showed more concise tissue incision and reduced collateral coagulation damage for Moses technology compared to the standard Holmium laser. Herein, we present our initial experience using Moses technology HoLEP in treating men with BPH.
In September 2018, 15 patients were treated with Moses technology HoLEP. Treatment indications were in accordance with the American urological association (AUA) guidelines for the surgical management of BPH. Patient and surgical characteristics were recorded. Additionally, voiding symptoms were assessed using AUA symptoms score and uroflowmetry parameters. Full video of each procedure was obtained and edited using open source software.
The median age of our cohort was 72 years. Median and mean preoperative prostate volume were 92 and 84 gram, respectively. 8 out of 15 patients (53%) required intermittent or indwelling catheter drainage before the procedure. Median enucleation time was 44 minutes. 15 out of 16 patients were outpatient procedures. One patient stayed overnight due to social issues. First voiding trial was attempted the morning following the surgery (catheterization time less than 16 hours). First voiding trial was successful in 80% of patients (n=12). The remaining three patients had a successful second voiding trial two days later. None of the included patients required continuous bladder irrigation, overnight stay or emergency department visit due to bleeding complications, within 30 days after the procedure.
Moses technology HoLEP is safe when performed as an outpatient procedure with excellent hemostatic potential up to 150 gram prostate volume. Further studies are warranted to compare Moses technology to standard Holmium laser.