TY - JOUR

T1 - 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

AU - Castellani, Daniele

AU - Di Rosa, Mirko

AU - Gómez Sancha, Fernando

AU - Rodríguez Socarrás, Moisés

AU - Mahajan, Abhay

AU - Taif Bendigeri, Mohammed

AU - Taratkin, Mark

AU - Enikeev, Dmitry

AU - Dellabella, Marco

AU - Gadzhiev, Nariman

AU - Somani, Bhaskar Kumar

AU - Herrmann, Thomas R W

AU - Gauhar, Vineet

N1 - © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2023/11

Y1 - 2023/11

N2 - 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.

AB - 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.

KW - Male

KW - Humans

KW - Prostate/surgery

KW - Lasers, Solid-State/therapeutic use

KW - Thulium/therapeutic use

KW - Prostatic Hyperplasia/surgery

KW - Quality of Life

KW - Retrospective Studies

KW - Propensity Score

KW - Treatment Outcome

KW - Laser Therapy/methods

U2 - https://doi.org/10.1007/s00345-023-04524-7

DO - https://doi.org/10.1007/s00345-023-04524-7

M3 - Article

C2 - 37515650

VL - 41

SP - 2915

EP - 2923

JO - World Journal of Urology

JF - World Journal of Urology

SN - 0724-4983

IS - 11

ER -