Skip to main content
SpringerLink
Log in

Does Moses technology enhance the efficiency and outcomes of regular holmium laser lithotripsy? Results of a pooled analysis of comparative studies

  • Original Article
  • Published:
Lasers in Medical Science Aims and scope Submit manuscript

Abstract

Holmium laser lithotripsy is currently the optimum standard for surgical treatment of upper urinary calculi. This study aims to evaluate the clinical efficacy and safety of Moses compared with conventional holmium laser lithotripsy for the treatment of patients with upper urinary calculi. We conducted a systematic search using multiple databases (PubMed/Medline, Scopus, Web of Science, and ClinicalTrials.gov) until June 2022. Clinical trials comparing Moses and conventional holmium laser lithotripsy were included. Analysis was performed using RevMan version 5.4.4 software. Four studies with 892 patients were included. There were no significant differences regarding stone-free rate (mean difference [MD] 1.19, 95% CI 0.54, 2.64, p = 0.66), operative time (MD − 9.31, 95% CI − 21.11, 2.48, p = 0.12), fragmentation time (MD − 1.71, 95% CI − 11.81, 8.38, p = 0.74), total energy used (MD 1.23, 95% CI − 0.44, 2.90, p = 0.15), auxiliary procedures (MD 0.38, 95% CI 0.08, 1.90, p = 0.24), and overall complications (odds ratio [OR] 0.70, 95% CI 0.30, 1.66, p = 0.42) between the groups. However, the laser working time (MD − 0.94, 95% CI − 1.20, − 0.67, p < 0.001) of Moses technology was shorter than that of conventional technology. Moses technology has similar outcomes to regular technology in terms of safety and efficacy. Given the higher operating costs of the Moses technology, further study is required to determine whether there are benefits to this new technology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Chen Z, Prosperi M, Bird VY (2018) Prevalence of kidney stones in the USA: the national health and nutrition evaluation survey. J Clin Urol 12:296–302

    Article  Google Scholar 

  2. Scales CD Jr, Tasian GE, Schwaderer AL, Goldfarb DS, Star RA, Kirkali Z (2016) Urinary stone disease: advancing knowledge, patient care, and population health. Clin J Am Soc Nephrol 11:1305–1312

    Article  PubMed  PubMed Central  Google Scholar 

  3. Noureldin YA, Kallidonis P, Liatsikos EN (2020) Lasers for stone treatment: how safe are they? Curr Opin Urol 30:130–134

    Article  PubMed  Google Scholar 

  4. Aldoukhi AH, Roberts WW, Hall TL, Ghani KR (2019) Watch your distance: the role of laser fiber working distance on fragmentation when altering pulse width or modulation. J Endourol 33:120–126

    Article  PubMed  Google Scholar 

  5. Ibrahim A, Badaan S, Elhilali MM, Andonian S (2018) Moses technology in a stone simulator. Can Urol Assoc J 12:127–130

    Article  PubMed  Google Scholar 

  6. Elhilali MM, Badaan S, Ibrahim A, Andonian S (2017) Use of the Moses technology to improve holmium laser lithotripsy outcomes: a preclinical study. J Endourol 31:598–604

    Article  PubMed  PubMed Central  Google Scholar 

  7. Winship B, Wollin D, Carlos E, Li J, Peters C, Simmons WN, Preminger GM, Lipkin M (2018) Dusting efficiency of the Moses holmium laser: an automated in vitro assessment. J Endourol 32:1131–1135

    Article  PubMed  Google Scholar 

  8. Mullerad M, Aguinaga JRA, Aro T, Kastin A, Goldin O, Kravtsov A, Assadi A, Badaan S, Amiel GE (2017) Initial clinical experience with a modulated holmium laser pulse-Moses technology: does it enhance laser lithotripsy efficacy? Rambam Maimonides Med J 8:e0038

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ibrahim A, Elhilali MM, Fahmy N, Carrier S, Andonian S (2020) Double-blinded prospective randomized clinical trial comparing regular and Moses modes of holmium laser lithotripsy. J Endourol 34:624–628

    Article  PubMed  PubMed Central  Google Scholar 

  10. Knoedler MA, Li S, Best SL, Hedican SP, Penniston KL, Nakada SY (2021) Clinical impact of the institution of Moses technology on efficiency during retrograde ureteroscopy for stone disease: single-center experience. J Endourol 36:65–70

    Article  PubMed  Google Scholar 

  11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  13. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605

    Article  PubMed  Google Scholar 

  14. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JAC, Cochrane Bias Methods Group; Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Bmj 343:d5928

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan A-W, Churchill R, Deeks JJ, Hróbjartsson A, Kirkham J, Jüni P, Loke YK, Pigott TD, Ramsay CR, Regidor D, Rothstein HR, Sandhu L, Santaguida PL, Schünemann HJ, Shea B, Shrier I, Tugwell P, Turner L, Valentine JC, Waddington H, Waters E, Wells GA, WhitingHiggins PFJPT (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  16. Luo D, Wan X, Liu J, Tong T (2018) Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 27:1785–1805

    Article  PubMed  Google Scholar 

  17. Pietropaolo A, Hughes T, Mani M, Somani B (2021) Outcomes of ureteroscopy and laser stone fragmentation (URSL) for kidney stone disease (KSD): comparative cohort study using MOSES technology 60 W laser system versus regular holmium 20 W laser. J Clin Med 10:2742

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Wang M, Shao Q, Zhu X, Wang Z, Zheng A (2021) Efficiency and clinical outcomes of Moses technology with flexible ureteroscopic laser lithotripsy for treatment of renal calculus. Urol Int 105:587–593

    Article  PubMed  Google Scholar 

  19. Dorantes-Carrillo LA, Basulto-Martínez M, Suárez-Ibarrola R, Heinze A, Proietti S, Flores-Tapia JP, Esqueda-Mendoza A, Giusti G (2022) Retrograde intrarenal surgery versus miniaturized percutaneous nephrolithotomy for kidney stones >1cm: a systematic review and meta-analysis of randomized trials. Eur Urol Focus 8:259–270

    Article  PubMed  Google Scholar 

  20. Ozbek R, Senocak C, Haberal HB, Damar E, Sadioglu FE, Bozkurt OF (2021) Comparison of scoring systems for predicting stone-free status and complications after retrograde ıntrarenal surgery. World J Urol 39:2741–2746

    Article  CAS  PubMed  Google Scholar 

  21. Ulvik Ø, Harneshaug JR, Gjengstø P (2021) What do we mean by “stone free”, and how accurate are urologists in predicting stone-free status following ureteroscopy? J Endourol 35:961–966

    Article  PubMed  Google Scholar 

  22. Dunne M, Drescher M, Abbott J, Davalos J (2021) MP18-04 lumenis pulse™ Moses™ technology improves efficiency of laser lithotripsy for patients undergoing mini-PCNL. J Urol 206:e318–e318

    Article  Google Scholar 

  23. Kandasami SV, Mamoulakis C, El-Nahas AR, Averch T, Tuncay OL, Rawandale-Patil A, Cormio L, de la Rosette JJ (2014) Impact of case volume on outcomes of ureteroscopy for ureteral stones: the clinical research office of the endourological society ureteroscopy global study. Eur Urol 66:1046–1051

    Article  PubMed  Google Scholar 

  24. Ofude M, Shima T, Yotsuyanagi S, Ikeda D (2017) Stone attenuation values measured by average hounsfield units and stone volume as predictors of total laser energy required during ureteroscopic lithotripsy using holmium:yttrium-aluminum-garnet lasers. Urology 102:48–53

    Article  PubMed  Google Scholar 

  25. Whitehurst L, Pietropaolo A, Geraghty R, Kyriakides R, Somani BK (2020) Factors affecting operative time during ureteroscopy and stone treatment and its effect on outcomes: retrospective results over 6.5 years. Ther Adv Urol 12:1756287220934403

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mandal S, Goel A, Singh MK, Kathpalia R, Nagathan DS, Sankhwar SN, Singh V, Singh BP, Sinha RJ, Dalela D (2012) Clavien classification of semirigid ureteroscopy complications: a prospective study. Urology 80:995–1001

    Article  PubMed  Google Scholar 

  27. El-Nahas AR, El-Tabey NA, Eraky I, Shoma AM, El-Hefnawy AS, El-Assmy AM, Soliman S, Youssef RF, El-Kenawy MR, Shokeir AA, El-Kappany HA (2009) Semirigid ureteroscopy for ureteral stones: a multivariate analysis of unfavorable results. J Urol 181:1158–1162

    Article  PubMed  Google Scholar 

  28. Komori M, Izaki H, Daizumoto K, Tsuda M, Kusuhara Y, Mori H, Kagawa J, Yamaguchi K, Yamamoto Y, Fukumori T, Takahashi M, Kanayama H-O, Sakaki M, Nakatsuji H, Hamao T, Miura H (2015) Complications of flexible ureteroscopic treatment for renal and ureteral calculi during the learning curve. Urol Int 95:26–32

    Article  PubMed  Google Scholar 

  29. Stern KL, Monga M (2018) The Moses holmium system - time is money. Can J Urol 25:9313–9316

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Jinze Li, Yin Huang, and Mengli Zhu contributed equally to this work.

Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Jinze Li, Yin Huang, Qiao Xiong, Daqing Tan, Qiang Wei, Dehong Cao & Liangren Liu

  2. West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, Sichuan, China

    Jinze Li, Yin Huang, Qiao Xiong & Daqing Tan

  3. Research Core Facility, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Mengli Zhu

  4. The Second People’s Hospital of Deyang City, Deyang, 618000, Sichuan, China

    Mengqi Chen

Authors
  1. Jinze Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yin Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mengli Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mengqi Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qiao Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daqing Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Qiang Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Dehong Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Liangren Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Dehong Cao or Liangren Liu.

Ethics declarations

Ethics approval

Not applicable for this type of study.

Informed consent

Not applicable for this type of study.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 18.4 KB)

Supplementary file2 (DOCX 357 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, J., Huang, Y., Zhu, M. et al. Does Moses technology enhance the efficiency and outcomes of regular holmium laser lithotripsy? Results of a pooled analysis of comparative studies. Lasers Med Sci 38, 73 (2023). https://doi.org/10.1007/s10103-023-03730-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10103-023-03730-4

Keywords

Search

Navigation