MoLEP vs. HoLEP for BPH: A 3-Year Greek Single-Center Retrospective Comparative Cohort Study on 1368 Cases

Abstract

Background: Holmium Laser Enucleation of the Prostate (HoLEP) is an established treatment for benign prostatic hyperplasia (BPH). Pulse-modulated lasers, like MOSES technology (MoLEP), may enhance the procedure’s efficiency and safety. Methods: A 3-year single-center retrospective comparative study was conducted on 1368 patients treated with HoLEP/MoLEP at MITERA Hospital. Results: A total of 688 patients were treated with HoLEP and 680 with MoLEP. Compared to HoLEP, MoLEP demonstrated shorter surgical (50.5 min [IQR 33–60] vs. 58 min [IQR 46–69], p < 0.01) and enucleation times (34 min [IQR 23–43] vs. 43 min [IQR 34–51], p < 0.001) and shorter hospital stay (8 h [IQR 6–19] vs. 12 h [IQR 9–24], p = 0.027), catheterization time (19 h [IQR 12–48] vs. 24 h [IQR 24–48], p < 0.001), and irrigation duration (5 h [IQR 2–8] vs. 7 h [IQR 3–10], p < 0.001), with similar morcellated tissue weight and morcellation time. At 1 month, MoLEP showed higher Qmax (27.3 mL/s [IQR 23.9–30.3] vs. 20 mL/s [IQR 17–23.6], p < 0.001), lower PVR (11.4 mL [IQR 7.7–15] vs. 12.5 mL [IQR 7–18], p = 0.005), better IPSS (4 [IQR 3–6] vs. 7 [IQR 5–11], p < 0.005), QoL (1 [IQR 1–2] vs. 2 [IQR 1–2], p < 0.001), lower PSA (1.8 ng/mL [IQR 1.1–2.6] vs. 2.4 ng/mL [IQR 1.3–3.5], p < 0.001), which were maintained at 6 months, and fewer Clavien-Dindo I (2.5% vs. 7.5%, p < 0.001) and II (16% vs. 25.7%, p < 0.001) complications. Conclusions: MoLEP offered significant advantages over HoLEP in this study.