What peri-operative outcomes are improved with pulse modulation for Holmium (Ho) Laser Enucleation of the Prostate (HoLEP)?

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Pulse Modulation for Holmium Laser Enucleation of the Prostate: Improved Perioperative Outcomes

Both decreased hemostasis time and decreased operative time (A&B) have been consistently reported as improved perioperative outcomes with pulse modulation for Holmium Laser Enucleation of the Prostate (HoLEP).

Evidence for Improved Perioperative Outcomes with Pulse Modulation

Decreased Hemostasis Time

  • The most recent evidence from a 2024 study comparing MOSES 2.0 vs MOSES 1.0 pulse-modulation technologies demonstrated significantly shorter hemostasis time with the newer pulse modulation technology (6 min vs 8 min, p = 0.002) 1.
  • A 2020 comparative study found that MOSES-enabled pulse laser modulation significantly reduced hemostasis time compared to standard laser fibers (6.3 ± 4.8 minutes vs 10.6 ± 6.1 minutes, p<0.001) 2.
  • A 2021 prospective double-blind randomized controlled trial showed that MOSES technology resulted in shorter hemostasis time compared to traditional HoLEP (mean: 18 vs 29 minutes, p<0.01) 3.
  • A 2024 randomized controlled trial demonstrated that MOSES-augmented HoLEP achieved hemostasis in significantly less time (6.6±4.2 minutes) compared to non-MOSES HoLEP (11.2±5.1 minutes) 4.

Decreased Operative Time

  • The 2024 study on MOSES 2.0 technology showed shorter median enucleation time (42.5 vs 52.5 min, p<0.001) compared to MOSES 1.0 1.
  • The 2021 double-blind randomized controlled trial demonstrated shorter total operative time with MOSES technology compared to traditional HoLEP (mean: 101 vs 126 minutes, p<0.01) 3.
  • The same study also showed shorter enucleation times with MOSES technology (mean: 68 vs 80 minutes, p=0.03) 3.

Additional Benefits of Pulse Modulation for HoLEP

Reduced Energy Requirements

  • MOSES 2.0 technology demonstrated lower laser energy usage (86.4 vs 101 kJ, p=0.012) compared to MOSES 1.0 1.

Decreased Blood Loss

  • The 2021 randomized controlled trial showed less blood loss with MOSES technology, measured by a smaller change in hematocrit postoperatively (mean: -6.3% vs -9.0%, p=0.03) 3.

Postoperative Care Benefits

  • The 2024 randomized controlled trial suggested potential advantages in postoperative care demands, shorter catheterization time, and reduced hospitalization with MOSES-augmented HoLEP 4.

Clinical Implications

HoLEP has been established as an effective surgical treatment option for benign prostatic hyperplasia (BPH) with several advantages over traditional TURP, including lower transfusion rates (2.6% vs 4.4%) 5. The introduction of pulse modulation technology like MOSES has further improved the efficiency of this procedure by:

  1. Enhancing the precision of tissue cutting
  2. Improving hemostasis capabilities
  3. Reducing overall operative time
  4. Potentially reducing blood loss

These improvements in perioperative parameters may translate to better patient outcomes, shorter hospital stays, and potentially lower complication rates, though the functional outcomes (IPSS, QoL, Qmax, PVR) appear comparable between traditional HoLEP and MOSES-enabled HoLEP 1.

Conclusion

Based on the most recent and highest quality evidence, pulse modulation for HoLEP consistently improves both hemostasis time and operative time compared to traditional HoLEP techniques.

References

5
Guideline

Benign Prostatic Hyperplasia Treatment Options

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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