A review of the Moses effect and its applications in endourology

The holmium:yttrium aluminum garnet laser, the gold standard for lithotripsy, is widely used in various endourological fields. Their physical characteristics contribute to the Moses effect. This narrative review aimed to analyze the current knowledge of the Moses effect and its applications in endourology. The Moses effect involves the rapid formation of a vapor bubble that allows the remaining energy to reach the target with less attenuation. Lumenis® developed pulse modulation technology, the MOSES™ technology, that harnesses the Moses effect to optimize holmium energy. Preclinical studies concluded that the new technology improves stone retropulsion, allowing for reduced lithotripsy duration. However, the heterogeneity of clinical studies and the lack of randomized controlled trials do not allow definitive conclusions. The MOSES™ technology has also been applied in holmium laser enucleation of the prostate, reducing enucleation and hemostasis times, leading to improved enucleation efficiency. However, minimal changes occurred in hemoglobin or hematocrit levels and no significant differences were noted in complications or functional outcomes. Further research is needed to fully evaluate the benefits and limitations of MOSES™ technology in clinical practice.