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

Overview

Journal World J Urol

Specialty Urology

Date 2023 Jul 29

PMID 37515650

Authors

Daniele Castellani

Mirko Di Rosa

Fernando Gomez Sancha

Moises Rodriguez Socarras

Abhay Mahajan

Mohammed Taif Bendigeri

Mark Taratkin

Dmitry Enikeev

Marco Dellabella

Nariman Gadzhiev

Bhaskar Kumar Somani

Thomas R W Herrmann

Vineet Gauhar

Affiliations

Soon will be listed here.

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.

Citing Articles

The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis.

Chen Y, Hua W, Huang Y, Shen X, You J, Ding X BMC Urol. 2024; 24(1):128.

PMID: 38886739 PMC: 11181543. DOI: 10.1186/s12894-024-01517-5.

Influence of Prostate Volume on the Incidence of Complications and Urinary Incontinence Following Thulium Fiber Laser Enucleation of the Prostate: Results from Multicenter, Real-world Experience of 2732 patients.

Castellani D, Enikeev D, Gokce M, Petov V, Gadzhiev N, Mahajan A Eur Urol Open Sci. 2024; 63:38-43.

PMID: 38558764 PMC: 10981004. DOI: 10.1016/j.euros.2024.03.004.

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