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Impact of pulse modulation technology on operating room time and blood loss in HoLEP: real-world data from an
Juanita Velasquez-Ospina1, Sabika Sadiq2, Ansh Bhatia3
1Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. juanitavelasquezo@gmail.com.
Purpose:
To compare perioperative and functional outcomes of standard holmium, Moses 1.0, and Moses 2.0 laser enucleation performed at an academic center with trainee involvement.
Methods:
We retrospectively reviewed men undergoing HoLEP between June 2022 and May 2024. Patients were grouped by laser platform: standard holmium, Moses 1.0, or Moses 2.0. Baseline demographics, perioperative data, complications, and functional outcomes up to six months were analyzed using analysis of variance or Kruskal-Wallis tests.
Results:
Among 389 patients (standard holmium 206; Moses 1.0 126; Moses 2.0 57), baseline characteristics were similar. Median operative times were 95, 105, and 100 min for standard holmium, Moses 1.0, and Moses 2.0, respectively (p = 0.25), and median prostate weights were comparable (84 g, 85 g, 79 g; p = 0.44). Hospital stay was slightly longer with Moses lasers (1.6 vs. 1.4 days, p < 0.001), though this difference is unlikely to be clinically significant. Objective measures of bleeding-postoperative hemoglobin drop (1.7-2.0 g/dL) and transfusion rates (0-1.6%)-did not differ significantly between groups. Postoperative catheter duration, hospital stay, and complication rates were also comparable. Functional outcomes improved in all groups through 6 months, with no intergroup differences.
Conclusion:
HoLEP is safe and effective across conventional holmium, Moses 1.0, and Moses 2.0 platforms, with comparable perioperative and functional outcomes. Although the literature suggests that Moses 2.0 may facilitate same-day discharge, its absence should not limit HoLEP availability, and platform selection may reasonably reflect institutional resources and surgeon preference.
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