Introduction: MOSES^TM technology may optimize energy delivery, resulting in more efficient hemostasis and enhanced visibility during holmium laser enucleation of the prostate (HoLEP). We sought to compare perioperative and postoperative outcomes and assess the safety and feasibility of same-day trial of void (TOV) in patients who underwent standard vs. MOSES HoLEP.

Methods: We retrospectively reviewed all patients who underwent standard (100 W) vs. MOSES (120 W) HoLEP with same-day catheter removal four hours postoperatively from August 2018 to September 2021. Patient demographics, intraoperative parameters, and postoperative outcomes were analyzed. Multivariate logistic regression analyses were used to identify independent predictors of enucleation time.

Results: Of the 90 patients included, 28 underwent standard HoLEP, while 62 had MOSES HoLEP. On unadjusted analyses, MOSES technology had significantly shorter enucleation time (p<0.001), hemostasis time (p<0.001), morcellation time (p=0.003), and lower energy use (p<0.001) (Table 1). Using the logistic regression model, we found that using MOSES technology (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.007–0.19, p<0.001), lower preoperative prostate-specific antigen (OR 1.25, 95% CI 1.01–1.55, p=0.03), and smaller prostate size (OR 1.06, 95% CI 1.02–1.09, p<0.001) were independent predictors of enucleation time. Upon unadjusted analyses, history of preoperative retention was the only significant factor affecting failed same-day TOV (p=0.04). There was no difference in the postoperative functional outcomes between both groups.

Conclusions: Our results demonstrate that MOSES technology enhances enucleation efficiency and has excellent hemostatic potential with no difference in the functional outcomesfor up to six months. Same-day TOV following HoLEP is feasible and safe.