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Holmium laser with MOSES technology (MoLEP) vs Thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis

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Abstract

Purpose

To compare Holmium laser with MOSES technology (MoLEP) and Thulium fiber laser enucleation of the prostate (ThuFLEP) in terms of surgical and functional outcomes.

Methods

We performed a retrospective analysis of all patients who underwent either procedure in five centers (January 2020–January 2022). Exclusion criteria: previous urethral/prostatic surgery, radiotherapy, concomitant surgery. Propensity score matching (PSM) analysis was performed to adjust for the bias inherent to the different characteristics at baseline. Differences between procedures were estimated using Firth Penalized Likelihood regression for International prostate symptom score (IPSS), quality of life (QL), maximum flow rate (Qmax).

Results

PSM retrieved 118 patients in each group. Baseline characteristics were similar except for PSA and number of men on indwelling catheter (higher in MoLEP group). Median surgical time was significantly longer in the MoLEP group despite the enucleation and morcellation times being similar. Median catheter dwelling time and postoperative length of stay were similar. Most of the early complications were Clavien ≤ 2 grade. There were only two Clavien grade 3 complications (one for each group), one grade 4 in MoLEP group. Rate and type of early and persistent incontinence (> 3 months) were similar. At 12-month, proportion of patients reaching a decrease (Δ) of IPSS ≥ 18 from baseline was significantly larger in MoLEP group, with no significant difference in ΔQmax > 12 ml/sec and ΔQL ≥ -3.

Conclusion

MoLEP and ThuFLEP were safe and efficacious procedures with similar short-term operative and functional outcomes. At 1-year, MoLEP patients had a sustained reduction of IPPS score.

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Data availability

Data is available on request from the authors.

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Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Urology Unit, IRCCS INRCA, Ancona, Italy

    Daniele Castellani & Marco Dellabella

  2. Urology Unit, Azienda Ospedaliero-Universitaria Delle Marche, Università Politecnica Delle Marche, Ancona, Italy

    Daniele Castellani

  3. Unit of Geriatric Pharmacoepidemiology and Biostatistics, Center for Biostatistic and Applied Geriatric Clinical Epidemiology, IRCCS INRCA, Via Santa Margherita 5, 60124, Ancona, Italy

    Mirko Di Rosa

  4. Department of Urology and Robotic Surgery, ICUA-Clínica CEMTRO, Madrid, Spain

    Fernando Gómez Sancha & Moisés Rodríguez Socarrás

  5. Department of Urology, Mahatma Gandhi Mission’s Medical College and Hospital, Aurangabad, India

    Abhay Mahajan

  6. Department of Urology, Asian Institute of Nephrology and Urology, Hyderabad, India

    Mohammed Taif Bendigeri

  7. Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russian Federation

    Mark Taratkin & Dmitry Enikeev

  8. Department of Urology, Medical University of Vienna, Vienna, Austria

    Dmitry Enikeev

  9. Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia

    Nariman Gadzhiev

  10. Department of Urology, University Hospitals Southampton NHS Trust, Southampton, UK

    Bhaskar Kumar Somani

  11. Department of Urology, Kantonspital Frauenfeld, Spital Thurgau AG, Frauenfeld, Switzerland

    Thomas R. W. Herrmann

  12. Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore

    Vineet Gauhar

Authors
  1. Daniele Castellani
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  2. Mirko Di Rosa
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  9. Marco Dellabella
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  12. Thomas R. W. Herrmann
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Contributions

Conception and design: VG, DC. Acquisition and analysis of data: MRS, FGS, AM, MTB, MT, DE, NG. Statistical analysis: MDiR. Drafting of the manuscript: VG, DC. Critical revision for important intellectual content: MD, BKS, TRWH. All authors participated in manuscript writing, review, and approval of the final version of the manuscript for submission.

Corresponding author

Correspondence to Mirko Di Rosa.

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Conflict of interest

Fernando Gomez-Sancha is a consultant for Quanta system and Lumenis. Thomas R.W. Herrmann is a consultant for, has received honoraria from, and is involved in research collaboration with Karl Storz.

Human rights

Institutional board review approval was obtained by the leading center (AINU 11/2022) and the remaining centers had approvals from their Institutional board.

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Castellani, D., Di Rosa, M., Gómez Sancha, F. et al. Holmium laser with MOSES technology (MoLEP) vs Thulium fiber laser enucleation of the prostate (ThuFLEP) in a real-world setting. Mid-term outcomes from a multicenter propensity score analysis. World J Urol 41, 2915–2923 (2023). https://doi.org/10.1007/s00345-023-04524-7

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