Moses and Moses 2.0 for Laser Lithotripsy: Expectations vs. Reality

Area of Science:

• Urology
• Medical Engineering
• Laser Technology

Background:

• Moses technology aims to control the Moses effect in Ho:YAG laser lithotripsy by dividing energy pulses.
• This pulse modulation technique delivers most energy in the second sub-pulse, aiming for improved stone fragmentation.

Purpose of the Study:

• To evaluate the efficacy and clinical benefits of Moses technology (MT) in Ho:YAG laser lithotripsy compared to conventional laser modes.
• To review existing literature on Moses 1.0 and 2.0 for endocorporeal laser lithotripsy.

Main Methods:

• A literature review was conducted, selecting clinical trials and laboratory studies of Moses 1.0 and 2.0 up to June 2022.
• Included studies compared Moses technology (MT) with standard low pulse (LP) and high pulse (HP) Ho:YAG lasers.

Main Results:

• Moses technology (MT 1.0) demonstrated shorter lasing times but reduced laser efficacy (higher J/mm³).
• No significant differences in lasing time, operative time, or stone-free rates were found when comparing MT 1.0 to regular mode HP Ho:YAG lasers.
• Moses 2.0 studies are limited; higher frequencies consumed more energy (J/mm³) for similar stone-free rates compared to MT 1.0.

Conclusions:

• Current evidence does not support the use of high-pulse Ho:YAG lasers with Moses technology over low-pulse Ho:YAG or TFL lasers.
• Further high-quality clinical trials are needed to validate the benefits of Moses 2.0 technology.