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En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes

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Abstract

Background and purpose

We aimed to describe the technique and outcomes of En-Bloc MOSES laser enucleation of the prostate (En-Bloc MoLEP) with early apical release comparing it to En-Bloc HoLEP (non-MOSES).

Patients and methods

This is a single-arm prospective study, using a historical control. n = 80 patients were enrolled to the En Bloc MoLEP group and compared to a retrospective group of n = 137 patients treated by En Bloc HoLEP (non-MOSES), in total n = 217 patients.

Results

En-Bloc MoLEP, showed to significantly improve the surgical time by 32% compared to non-MOSES HoLEP (32.16 ± 14.46 min, 47.58 ± 21.32, respectively; P = 0.003). Enucleation time, ablation rate and hemostasis time were also significantly improved (P < 0.001, for all three parameters). Enucleation time was 22.10 ± 9.27 min and 31.46 ± 14.85 min (P < 0.001), ablation rate 4.11 ± 2.41 and 2.54 ± 1.31 gr/min (P < 0.001), Hemostasis time 3.01 ± 2.50 and 8.35 ± 5.38 min (P < 0.001), for En Bloc MoLEP and En Bloc HoLEP, respectively. Q-max, PVR, PSA and IPSS showed significant improvement, however, at 12 months no significant differences were observed comparing both groups.

Conclusions

En-Bloc MoLEP was significantly better than En-Bloc HoLEP in terms of surgical time, enucleation time, ablation rate and hemostasis time. However, large comparative RCT with long-term follow-up are needed.

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Funding

No funding was received for this article. Lumenis Ltd, Yokneam, Israel provided laser fibers for the surgeries of the patients included in the study arm.

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Authors and Affiliations

  1. Instituto de Cirugía Urológica Avanzada (ICUA), Clínica Cemtro, Madrid, Spain

    Moisés Rodríguez Socarrás, Julio Fernández del Álamo, Fabio Espósito, Javier Reinoso Elbers, Diego Carrión Monsalve, Juan Gómez Rivas, Isabella Greco, Luis LLanes González, Vanesa Cuadros Rivera & Fernando Gómez Sancha

Authors
  1. Moisés Rodríguez Socarrás
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  2. Julio Fernández del Álamo
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  3. Fabio Espósito
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  4. Javier Reinoso Elbers
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  5. Diego Carrión Monsalve
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  6. Juan Gómez Rivas
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  7. Isabella Greco
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  8. Luis LLanes González
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  9. Vanesa Cuadros Rivera
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  10. Fernando Gómez Sancha
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Contributions

MRS: protocol/project development, data collection and management, data analysis, manuscript writing/editing. JFA: protocol/project development. FE: data collection, data analysis, manuscript writing/editing. JRE: protocol/project development. DCM: protocol/project development. JGR: protocol/project development. IG: protocol/project development. LLG: protocol/project development VCR protocol/project development, data collection and management, data analysis. FGS: protocol/project development, data collection or management, manuscript writing/editing.

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Correspondence to Moisés Rodríguez Socarrás.

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FGS is a consultant for Lumenis Ltd.

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A written informed consent was obtained from all patients.

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Socarrás, M.R., del Álamo, J.F., Espósito, F. et al. En Bloc enucleation with early apical release technique using MOSES (En Bloc MoLEP) vs. classic En Bloc HoLEP: a single arm study comparing intra- and postoperative outcomes. World J Urol 41, 159–165 (2023). https://doi.org/10.1007/s00345-022-04205-x

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