Next-Generation Moses Pulse Modulation: An Evaluation of Whether This Is Hype or Breakthrough

Next-generation Moses™ technology is a pulse modulation modality of the traditional holmium yttrium-aluminum-garnet (YAG) laser and has been developed for use in both laser lithotripsy and prostate enucleation. In traditional holmium YAG lasers, the energy is delivered in a single continuous pulse, which can be less efficient in terms of stone fragmentation and tissue interaction. Moses technology, on the other hand, uses multiple, shorter pulses within a single laser firing cycle, which makes the energy delivery more controlled and effective. In pre-clinical studies, Moses™ technology has been shown to improve stone fragmentation efficiency in lithotripsy and reduce overall procedure time in prostate enucleation. Given its relatively recent introduction, it is still unclear if use of Moses™ can translate to efficiency and time savings in the operating room. The aim of this narrative review is to summarise the latest evidence for use of Moses™ technology in the treatment of urolithiasis and prostate enucleation. To compare Moses™ to standard holmium, a literature review was conducted in PubMed and Embase for randomised controlled trials and cohort studies. For laser lithotripsy, outcomes investigated were overall procedure time, fragmentation time, degree of retropulsion, stone-free rate and complications. For prostate enucleation, the outcomes were operative time and haemostasis time. This review summarises current comparative findings between Moses™ and conventional holmium:YAG laser in the context of lithotripsy and prostate enucleation, highlighting consistent advantages in key operative metrics across both applications. Current literature evidence suggests Moses™ technology is associated with superior outcomes compared to standard holmium YAG laser in several key parameters determining the overall efficiency. For urolithiasis, Moses™ could offer shorter procedure times and for prostate enucleation, it could reduce the learning curve of HoLEP, enabling it to become an outpatient-based procedure.