Impact of Moses technology on HoLEP day-case success rate: a monocentric matched paired cohort study

Moses pulse modulation technology has been shown to improve enucleation efficiency and hemostasis during holmium laser enucleation of the prostate (HoLEP). Whether these technical advantages translate into better outcomes in a day-case setting remains unclear. We aimed to evaluate the impact of Moses 2.0 technology on day-case HoLEP success.

We conducted a single-center matched-pair cohort study comparing day-case HoLEP performed with Moses 2.0 technology to conventional HoLEP. A prospective cohort of 100 consecutive Moses patients (June 2023-April 2025) was matched 1:1 by propensity score to a retrospective cohort of 100 conventional HoLEP patients (2015-2025), based on age, IPSS, prostate volume, voiding status, and antiplatelet/anticoagulant therapy. The primary endpoint was day-case success, defined as discharge on postoperative day 0 without readmission within 48 h. Secondary outcomes included perioperative variables, complications, and functional outcomes at 3 months.

After matching, baseline characteristics were well balanced between groups. Day-case success rates were 86% in the conventional group and 89% in the Moses group (p = 0.5). Persistent hematuria requiring prolonged bladder irrigation was the main cause of failure in both groups. Postoperative complication rates were similar (14% vs. 12%, p = 0.5), and no patient required blood transfusion. At 3 months, functional outcomes including Qmax, post-void residual volume, PSA, and IPSS were comparable between groups.

In this large propensity-matched cohort of day-case HoLEP, Moses 2.0 technology was safe but did not significantly improve day-case success compared with conventional HoLEP. Although Moses technology enhances intraoperative laser performance, its clinical benefit in an expert outpatient setting appears limited. Further studies should identify subgroups that may derive greater benefit from this technology.