We sought to compare intraoperative and one-year postoperative outcomes of patients treated for benign prostatic hyperplasia (BPH) with either holmium laser enucleation of the prostate using MOSESTM technology (M-HoLEP) or thulium fiber laser enucleation of the prostate (ThuFLEP).

We included 104 patients who underwent endoscopic enucleation of the prostate (EEP) using either MOSESTM technology or thulium fiber laser (TFL) between June 2022 and January 2024 in this randomized controlled trial (RCT). Patients’ preoperative and prostate data were evaluated. Intraoperative data and perioperative outcomes, including hospital admission, perioperative complications, readmission rates, and measures such as IPSS, QoL, flow rate, PVR, PSA, and TRUS-size reduction, were collected and analyzed over a 12-month follow-up period.

Of the 104 patients in the study, 52 underwent M-HoLEP, and 52 were managed with ThuFLEP. There were no statistically significant differences in preoperative characteristics between the two groups. Patients in the M-HoLEP group had a shorter median enucleation time (50 vs. 57.5 minutes, p<0.001) and demonstrated significantly higher enucleation efficiency than the ThuFLEP group (1.97 vs. 1.49 g/min, p<0.001). Furthermore, significant differences were observed in favor of M-HoLEP regarding continuous bladder irrigation (CBI) time, hematuria scale, duration of postoperative hematuria, catheterization time, and length of hospital stay. Approximately 30.8% of ThuFLEP patients were admitted with immediate postoperative hematuria compared to 7.7% in the M-HoLEP group, p=0.003. Postoperative outcomes, including IPSS, QoL, Qmax, PVR, PSA and TRUS-size reduction, were comparable between the two cohorts up to 12 months postoperatively. Two patients (3.8%) from the ThuFLEP group had bladder neck contractures until the final follow-up visit.

Both TFL and MOSESTM technology achieved satisfactory intraoperative and postoperative functional outcomes in EEP. However, MOSESTM technology demonstrated superior results in terms of enucleation time, enucleation efficiency, catheterization time, and hospital stay. M-HoLEP facilitates same-day trial of void (TOV) and reduces the rate of postoperative hospital admissions.