Introduction: Holmium laser enucleation of the prostate (HoLEP) is a longstanding surgical treatment for benign prostatic hyperplasia (BPH). The thulium fiber laser is the newest laser currently available and possibly offers better hemostatic properties; however, there is a paucity of data on outcomes in BPH treatment. This prospective study aimed to compare the safety profile, as well as the intraoperative and clinical outcomes between HoLEP with Moses technology (m-HoLEP) and thulium fiber laser enucleation of the prostate (TFLEP).

Methods: Twenty patients were included in this prospective study after obtaining institutional review board approval. Two experienced surgeons were involved in this study: one performed 10 m-HoLEP procedures, while the other performed 10 TFLEP procedures. Demographic information of patients was collected, as well as intraoperative variables and complications. Statistical analyses were performed on SPSS Statistics Version 27.

Results: TFLEP and m-HoLEP patients were similar in age (72.3 vs 75.4 years, respectively, p=0.45) and prostate size (131.3 vs 123.3 cc, respectively, p=0.67). There was no difference in American Society of Anesthesiologists (ASA) score (p=0.50) and anticoagulant usage (p=0.54) between both groups. The duration of morcellation was similar in both groups (p=0.44). Hemoglobin reduction was similar in m-HoLEP compared to TFLEP (18.0 vs 17.3 g/L, respectively, p=0.67). Length of hospitalization was comparable in both study arms (p=0.16). There was no difference in mean duration (p=0.23) or rate (p=0.54) of enucleation between both laser modalities. Complications, such as urosepsis, re-admission, and transfusion, did not vary between m-HoLEP and TFLEP groups.

Conclusions: Although preliminary, the results of this study demonstrate similar perioperative and clinical outcomes for TFLEP and m-HoLEP. This study is ongoing, with a total recruitment of 50 per arm planned and an anticipated followup period of one year.