Endoscopic enucleation of the prostate (EEP) is a well-regarded treatment for benign prostatic obstruction (BPO), but direct comparisons of laser technologies used in this procedure remain limited. Specifically, this study compares the MOSES™ holmium laser technology (MoLEP) and thulium fiber laser (TFL) enucleation (ThuFLEP) based on cases performed at a single institution. Between December 2020 and October 2023, a total of 316 EEP procedures were conducted by a single surgeon using MOSES™ and TFL technologies after obtaining informed patient consent. Of these, 146 MoLEP procedures were performed using MOSES™ 1.0 and 50 with MOSES™ 2.0 pulse-modulation systems (Lumenis, Israel), while 120 cases used the ThuFLEP (Soltive™ Premium, Olympus, USA). Video recordings of these procedures were analyzed to assess the performance of each energy source during EEP.
The effectiveness of EEP depends on several factors, including laser-tissue interaction, wavelength, absorption coefficient, peak power, working distance, and the surgeon’s skill. While TFL behaves like a “hot knife,” excising tissue with precision but offering limited aid in dissecting anatomical planes, the MOSES™ technology operates more like scissors, opening the layer between adenoma and capsule to help surgeons follow the true anatomical path. Despite these differences, both techniques achieved favorable outcomes in terms of complete adenoma removal. Early results from the institution’s randomized controlled trial (RCT) suggest that the new pulse-modulation holmium lasers (MOSES™ 2.0) offer clinical advantages in intraoperative and perioperative outcomes, such as reduced bleeding and faster procedure times. However, additional large-scale RCTs are needed to validate these preliminary findings.
