Introduction: We evaluated perioperative and postoperative outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) using a newly-optimized modification of Moses technology (M-HoLEP), and compared them to a recent cohort of patients who underwent HoLEP with a standard holmium laser.
Methods: We prospectively collect clinical data on all patients undergoing HoLEP at our institution. We began performing M-HoLEP in June 2019 and included all patients through September 2019. M-HoLEP is performed with a 550µm Moses fiber. We then compared these patients to the most recent 50 patients with full data available in whom standard HoLEP was performed using a non-Moses 550µm laser fiber. Peri-operative and postoperative outcomes were compared between M-HoLEP and standard HoLEP groups. Of note, we have made a practice change to more routinely discharge patients home on the same day as surgery since initiating M-HoLEP, as opposed to routinely admitting patients for 1 night.
Results: We included 112 patients for analysis, with 62 (55.4%) patients in the M-HoLEP group. M-HoLEP and standard groups had similar age (mean 72 vs 71 years, respectively; p=0.732) and BMI (mean 28.2 vs 28.0, respectively; p=0.669), and a similar proportion of patients underwent cystolitholapaxy in the same setting (12.9% vs 10.0%, respectively; p=0.770). M-HoLEP and standard HoLEP required similar overall time for enucleation (mean 46 vs 47 minutes, respectively; p=0.729) and morcellation (mean 10 vs 12 minutes, respectively; p=0.561), as well as a similar amount of time spent specifically on tissue cutting (mean 24 vs 23 minutes, respectively; p=0.395). Interestingly, M-HoLEP required less time spent on tissue coagulation for hemostasis compared to standard HoLEP (8 vs 11 minutes, respectively; p=0.035). No patients in the standard group were discharged home on the same day as surgery, whereas 69.4% of M-HoLEP patients were discharged home the same day. Despite this practice change, we still observed a low percentage of patients requiring repeat bladder catheterization for bleeding or failure to void between M-HoLEP and standard groups (3.2% vs 6.0%, respectively; p=0.655).
Conclusions: Performing HoLEP with the newly-optimized optimized of Moses technology requires less intraoperative hemostasis and still permits excellent outcomes. Additionally, selected patients for same-day discharge have no increased risk of a repeat catheterization for bleeding of failure to void. Source of