Thulium fiber laser versus holmium MOSES^TM laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized prospective clinical study

Background: We aimed to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with holmium laser enucleation of the prostate using MOSES^TM technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP). Methods: We included 104 patients who underwent M-HoLEP or ThuFLEP between June 2022 and January 2024 in this randomized controlled trial. Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes were analyzed over the 12-month follow-up period. Results: Fifty-two patients underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in the preoperative characteristics between the groups. M-HoLEP had a shorter median enucleation time (50 vs. 57.5 minutes, p < 0.001) and demonstrated significantly higher enucleation efficiency than ThuFLEP (1.97 vs. 1.49 g/min, p < 0.001). Significant differences were observed favoring M-HoLEP regarding continuous bladder irrigation time, hematuria scale, duration of postoperative hematuria, catheterization time, and hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria versus 7.7% in the M-HoLEP group, p = 0.003). The postoperative outcomes were comparable between the cohorts up to 12 months. Conclusions: Thulium fiber laser (TFL) and MOSES^TM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSES^TM technology demonstrated superior results in terms of enucleation time and efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial-of-void and reduces postoperative hospital admissions.