ThuFLEP and M-HoLEP achieve comparable functional outcomes in BPH

Holmium laser enucleation of the prostate using MOSES technology (M-HoLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) were both safe and effective and led to comparable functional outcomes in patients with benign prostatic hyperplasia (BPH), according to data from a randomized controlled trial (RCT) published in Prostate Cancer Prostatic Disease.¹

However, the study also showed that the M-HoLEP procedure was superior in terms of enucleation time and efficiency, catheterization time, and hospital stay.

In total, the open-label trial included 104 patients who were randomly assigned 1:1 to receive M-HoLEP (n = 52) or ThuFLEP (n = 52). Patients included in the study had been referred to urology for refractory lower urinary tract symptoms or urinary retention secondary to BPH and had failed prior medical treatment.² Baseline characteristics were similar between both arms. The median prostate volume was 110 mL in the M-HoLEP arm and 103 mL in the ThuFLEP arm.

The primary end point for the study was the length of stay in the hospital. Secondary outcome measures included safety via intraoperative complications, bleeding incidence, operative time, and time to catheter removal. The investigators also assessed postoperative functional outcomes.

Overall, M-HoLEP demonstrated a shorter median enucleation time and significantly higher enucleation efficiency vs ThuFLEP. Specifically, the median enucleation time was 50 minutes with the M-HoLEP procedure vs 57.5 minutes with the ThuFLEP procedure (P < .001). Further, the enucleation efficiency was 1.97 g/min with M-HoLEP compared with 1.49 g/min with ThuFLEP (P < .001).

The average hospital stay was also significantly longer for patients who underwent ThuFLEP. Specifically, the mean hospital stay was 6.3 hours in the M-HoLEP arm vs 11.9 hours in the ThuFLEP arm (P = .016).

The authors also reported, “Our study identified differences across all investigated hemostasis parameters. While hemostasis time did not differ significantly, immediate postoperative outcomes, including hemoglobin drop, CBI time, postoperative hematuria duration, and hematuria scale in both the operating and recovery rooms, significantly favored M-HoLEP in our hands.”

In total, 7.7% of patients in the M-HoLEP cohort vs 30.8% of patients in the ThuFLEP cohort were admitted with immediate postoperative hematuria (P = .003).

However, postoperative functional outcomes were similar between both arms through 12 months.

The average prostate size was comparable between both cohorts (P = .3) at 6 months following the procedure, with no significant differences noted in the percentage of prostate-specific antigen reduction (P = .72) or TRUS-size reduction (P = .51) between the 2 arms. Both groups also showed no significant difference in sexual outcomes at 12 months (P = .69).

One patient in each cohort (1.9%) experienced stress urinary incontinence (SUI; P = 1) at 3 months following the procedure. However, no patients reported persistent SUI at the final follow-up visit.

Overall, grade 1 complications were observed in 19.2% of patients in the M-HoLEP arm and 42.3% of patients in the ThuFLEP arm. Further, 6.2% of patients in the M-HoLEP arm and 19.4% of patients in the ThuFLEP arm failed same-day trial of void (TOV) following the procedure (P = .06), but all patients passed their TOV within 1 week.

No grade 4 of 5 complications were reported in either arm.

Based on these data, the authors concluded, “M-HoLEP and ThuFLEP are safe and effective BPH treatments with comparable functional outcomes. However, ThuFLEP demonstrated lower ambulatory success. Laser choice should depend on the urologist’s preference and expertise, prioritizing patient safety. Larger RCTs are needed to determine whether one technique offers significant clinical advantages.”

REFERENCES

1. 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. doi:10.1038/s41391-025-00996-3

2. Thulium Fiber Laser (TFL) vs Holmium MOSES for treatment of benign prostatic hyperplasia (BPH). ClinicalTrials.gov. Last updated August 16, 2024. Accessed July 28, 2025. https://clinicaltrials.gov/study/NCT05240001