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

Prostate Cancer and Prostatic Diseases (2025)Cite this article

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Abstract

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 MOSESTM 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 MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in endoscopic enucleation of the prostate. However, MOSESTM 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.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author (H.E.) on reasonable request.

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Acknowledgements

The authors acknowledge the financial support provided by Boston Scientific in the form of a research grant for this study. The sponsor had no role in the study design, data collection, analysis, interpretation, or manuscript preparation.

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Authors and Affiliations

  1. Department of Urology, Northern Ontario School of Medicine, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON, Canada

    Hazem Elmansy, Saud Alhelal, Oksana Blahitko, Ryan Kelly, Ruba Abdul Hadi, Husain Alaradi, Khaled Alotaibi, Ahmed Mousa & Ahmed S. Zakaria

  2. Department of Urology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

    Amr Hodhod

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  1. Hazem Elmansy
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  2. Saud Alhelal
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Contributions

Hazem Elmansy: Conception and design, data acquisition, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript for scientific and factual content, supervision. Saud Alhelal: Data acquisition, critical revision of the manuscript for scientific and factual content, quality control. Oksana Blahitko: Data acquisition, drafting the manuscript, quality control. Ryan Kelly: Conception and design, critical revision of the manuscript for scientific and factual content, quality control. Amr Hodhod: Data analysis and interpretation, drafting the manuscript, critical revision of the manuscript for scientific and factual content, statistical analysis. Ruba Abdul Hadi: Conception and design, drafting the manuscript, critical revision of the manuscript for scientific and factual content, quality control. Husain Alaradi: Data acquisition, critical revision of the manuscript for scientific and factual content, quality control. Khaled Alotaibi: Data acquisition, critical revision of the manuscript for scientific and factual content, quality control. Ahmed Mousa: Conception and design, critical revision of the manuscript for scientific and factual content, quality control. Ahmed S. Zakaria: Conception and design, critical revision of the manuscript for scientific and factual content, supervision.

Corresponding author

Correspondence to Hazem Elmansy.

Ethics declarations

Competing interests

H. Elmansy is an Investigator for Urotronic Inc. (Laborie) and Zenflow Inc. He previously received honoraria and is the recipient of a research grant from Boston Scientific. The other co-authors do not have a conflict of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Elmansy, H., Alhelal, S., Blahitko, O. et al. Thulium fiber laser versus holmium MOSESTM laser enucleation of the prostate for the treatment of benign prostatic hyperplasia: a randomized prospective clinical study. Prostate Cancer Prostatic Dis (2025). https://doi.org/10.1038/s41391-025-00996-3

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