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The benefits of holmium laser enucleation of the prostate with MOSES-enabled pulsed laser modulation justify its consideration as the gold standard surgical treatment for lower urinary tract symptoms related to benign prostatic hyperplasia, according to Amy E. Krambeck, MD.
The benefits of holmium laser enucleation of the prostate with MOSES-enabled pulsed laser modulation justify its consideration as the gold standard surgical treatment for lower urinary tract symptoms related to benign prostatic hyperplasia (BPH), according to Amy E. Krambeck, MD.
Krambeck said that after learning holmium laser enucleation of the prostate (HoLEP) in 2008 during her endourology fellowship training, she relied on it exclusively for surgical treatment of BPH after joining the urology department at Mayo Clinic in Rochester, Minnesota, in 2009. In late 2018, Krambeck had the opportunity to trial HoLEP with the MOSES laser platform. She told Urology Times® that she was immediately impressed by its better hemostasis during the enucleation phase, which translated into enhanced visualization, decreased operative time, and reduced postoperative patient care.
After just 10 cases, Krambeck adopted MOSES laser enucleation of the prostate (MoLEP) as her sole technique for surgical BPH treatment. Based on outcomes observed during accumulating experience, Krambeck and her 2 partners are now performing MoLEP as an outpatient procedure, and
they are even discharging patients home without a catheter if they are operated on early in the day.
“Compared with other surgical techniques for symptomatic BPH, HoLEP was associated with less bleeding, shorter catheter times, fewer infections, and better durability, and it can be used regardless of prostate size and use of anticoagulants,” said Krambeck, Michael O. Koch Professor of Urology at Indiana University School of Medicine, Indianapolis.
“MoLEP takes HoLEP to the next level. Because it has better hemostasis, MoLEP eliminates the need for overnight bladder irrigation and for checking lab values the next day. By allowing same-day discharge, MoLEP avoids exposing patients to nosocomial risks, saves costs, and frees up inpatient resources for higher acuity patients.”
In a paper published in Urology (2020;136:196- 201), Krambeck and colleagues reported on the benefits of MoLEP compared with HoLEP in a retrospective study in men with symptomatic BPH who were operated on between August 2018 and January 2019. In April 2019, they began sending MoLEP patients home the same day unless an inpatient stay was deemed necessary because of significant medical comorbidities or concurrent other procedures.
Same-day catheter removal for the first 2 cases of the day was implemented in December 2019 and has been successful in about 90% of attempts. Men operated on later in the day go home with their catheter. Depending on their circumstances, men may be allowed to remove the catheter at home the next day, and if they reported they are doing well during a telephone follow-up, they are next seen 3 months later.
Krambeck observed that MoLEP is also a narcotic-free procedure.
“Most patients tell me that they had no pain at all postoperatively.
Some men will experience burning when they urinate, but it is easily managed with an anti-inflammatory medication and only affects about 5% of patients,” she said.
Krambeck and colleagues had planned to present their experience with outpatient MoLEP at the now-canceled AUA annual meeting as well as the World Congress of Endourology. They are writing up the manuscript for a paper that reviews outcomes from 112 MoLEP patients compared to standard HoLEP that will be submitted to the Journal of Endourology.
“MoLEP is relatively new, and I am not aware of reports about its outcomes from any other centers. The best way to assess new technology outcomes is to assess experience and outcomes at multiple institutions. I encourage others performing the MoLEP procedure to analyze their own results,” she said.
Krambeck is a clinical consultant for Boston Scientific and Lumenis. She is also the chair of the Data Safety Monitoring Board for Sonomotion.