Moses Technology Research Articles

Comparison of Moses laser and Raykeen laser in patients with impacted upper ureteral stone undergoing flexible ureteroscopic holmium laser lithotripsy

BackgroundTo compare the operative effect and clinical efficacy of the Moses laser mode and the Raykeen holmium laser energy platform powder mode under flexible ureteroscopic lithotripsy in patients with impacted upper ureteral stones.MethodsFrom March 2022 to September 2022, 72 patients were divided into a Moses laser group and a Raykeen laser group according to surgical method, with 36 patients in each group. CT and ureteroscopy confirmed that all patients had isolated impacted upper ureteral stones. The stone volume (mm3), stone density (Hu) and severity of hydronephrosis were measured by CT. Postoperative complications were evaluated using the Clavien–Dindo score.ResultsThere were no complications of ureteral stenosis related to the laser treatment. The operative time and lithotripsy time were lower in the Moses laser group than in the Raykeen laser group (P < 0.05). The stone-free survival rate did not differ significantly between the two groups (P = 0.722). Stone volume was found to be positively correlated with laser energy and lithotripsy time in both groups (P < 0.01). There was no significant correlation between laser energy and lithotripsy time or ureteral stone density (Hu) in the Moses laser group (P > 0.05) or the Raykeen laser group (P > 0.05).ConclusionsThe contact mode of Moses technology and the powder mode of Raykeen laser lithotripsy can be used for the ablation of a single impacted upper ureteral stone. The ablation speed was related to the stone volume and the severity of polyp hyperplasia, not the stone density. We recommend the use of the powdered mode as a therapeutic measure for the treatment of impacted upper ureteral stones in flexible ureteroscopic lithotripsy.

Holmium:yttrium-aluminium-garnet laser with MOSES technology is more efficient than thulium fibre laser in supine mini-percutaneous nephrolithotomy.

To address the paucity of literature comparing outcomes achieved with utilisation of the high-power holmium:yttrium-aluminium-garnet (Ho:YAG) laser with MOSES technology vs those achieved with the thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (PCNL). A retrospective review was performed of patients undergoing supine mini-PCNL between August 2021 and May 2023. Exclusion criteria were urinary diversion, simultaneous utilisation of >1 laser platform, use of any other form of fragmentation, and ureteric stones. The Ho:YAG platform (Lumenis Pulse P120H™ with MOSES technology, 120W; Boston Scientific®) and the TFL (Soltive SuperPulsed Thulium Fibre [SPTF], 60W; Olympus®) were compared. Data on stone-free rate (SFR) were determined by computed tomography performed on the first postoperative day and presented as absence of stone fragments, no fragments larger than 2 mm, or no fragments larger than 4 mm. A total of 100 patients met the inclusion criteria, 51 mini-PCNLs with the Ho:YAG laser and 49 with the SPTF laser. No significant differences in demographics or stone characteristics were detected between the two groups. The Ho:YAG laser utilised less energy and time, resulting in higher ablation efficiency (P < 0.05) and less total operating time (P < 0.05). Overall, there was no difference in SFR in any category between the Ho:YAG group and the SPTF group (no fragments: relative risk [RR] 0.81, 95% confidence interval [CI] 0.59-1.12, P = 0.21; fragments <2 mm: RR 0.86, 95% CI 0.67-1.10, P = 0.23; fragments <4 mm: RR 0.96, 95% CI 0.80-1.15, P = 0.67). Although we observed an equivalent postoperative SFR, this study supports a shorter operating time and greater intra-operative laser efficiency with the Ho:YAG laser over the SPTF laser in mini-PCNL.

What is the definition of stone dust and how does it compare with clinically insignificant residual fragments? A comprehensive review.

During endoscopic stone surgery, Holmium:YAG(Ho:YAG) and Thulium Fiber Laser(TFL) technologies allow to pulverize urinary stones into fine particles, ie DUST. Yet, currently there is no consensus on the exact definition of DUST. This review aimed to define stone DUST and Clinically Insignificant Residual Fragments(CIRF). Embase, MEDLINE(PubMed) and Cochrane databases were searched for both in vitro and in vivo articles relating to DUST and CIRF definitions, in November 2023, using keyword combinations: "dust", "stones", "urinary calculi", "urolithiasis", "residual fragments", "dusting", "fragments", "lasers" and "clinical insignificant residual fragments". DUST relates to the fine pulverization of urinary stones, defined in vitro as particles spontaneously floating with a sedimentation duration ≥ 2sec and suited for aspiration through a 3.6Fr-working channel(WC) of a flexible ureteroscope(FURS). Generally, an upper size limit of 250µm seems to agree with the definition of DUST. Ho:YAG with and without "Moses Technology", TFL and the recent pulsed-Thulium:YAG (pTm:YAG) can produce DUST, but no perioperative technology can currently measure DUST size. The TFL and pTm:YAG achieve better dusting compared to Ho:YAG. CIRF relates to residual fragments(RF) that are not associated with imminent stone-related events: loin pain, acute renal colic, medical or interventional retreatment. CIRF size definition has decreased from older studies based on Shock Wave Lithotripsy(SWL)(≤ 4mm) to more recent studies based on FURS(≤ 2mm) and Percutaneous Nephrolithotomy(PCNL)(≤ 4mm). RF 2mm are associated with lower stone recurrence, regrowth and clinical events rates. While CIRF should be evaluated postoperatively using Non-Contrast Computed Tomography(NCCT), there is no consensus on the best diagnostic modality to assess the presence and quantity of DUST. DUST and CIRF refer to independent entities. DUST is defined in vitro by a stone particle size criteria of 250µm, translating clinically as particles able to be fully aspirated through a 3.6Fr-WC without blockage. CIRF relates to ≤ 2 RF on postoperative NCCT.

Getting hot in here! Comparison of Holmium vs. thulium laser in an anatomic hydrogel kidney model.

As laser technology has advanced, high-power lasers have become increasingly common. The Holmium: yttrium-aluminum-garnet (Ho:YAG) laser has long been accepted as the standard for laser lithotripsy. The thulium fiber laser (TFL) has recently been established as a viable option. The aim of this study is to evaluate thermal dose and temperature for the Ho:YAG laser to the TFL at four different laser settings while varying energy, frequency, operator duty cycle (ODC). Utilizing high-fidelity, 3D-printed hydrogel models of a pelvicalyceal collecting system (PCS) with a synthetic BegoStone implanted in the renal pelvis, laser lithotripsy was performed with the Ho:YAG laser or TFL. At a standard power (40W) and irrigation (17.9ml/min), we evaluated four different laser settings with ODC variations with different time-on intervals. Temperature was measured at two separate locations. In general, the TFL yielded greater cumulative thermal doses than the Ho:YAG laser. Thermal dose and temperature were typically greater at the stone when compared away from the stone. Regarding the TFL, there was no general trend if fragmentation or dusting settings yielded greater thermal doses or temperatures. The TFL generated greater temperatures and thermal doses in general than the Ho:YAG laser with Moses technology. Temperatures and thermal doses were greater closer to the laser fiber tip. It is inconclusive as to whether fragmentation or dusting settings elicit greater thermal loads for the TFL. Energy, frequency, ODC, and laser-on time significantly impact thermal loads during ureteroscopic laser lithotripsy, independent of power.

Assessment of stone ablation rate using the Moses technology modes with different energy and pulse settings: An experimental study

ABSTRACT Objectives To compare lithotripsy ablation rate with the Moses modes versus conventional pulse modes when using the Holmium:Yttrium–Aluminum–Garnet (Ho:YAG) laser. Methods The Lumenis® Pulse P120H Holmium Laser System and a 365 μm Moses D/F/L fiber were used to assess stone ablation rate in conventional Short and Long Pulse as well as Moses Contact and Distance at 10 W (0.5Jx20Hz and 2Jx5Hz) and 60 W (1Jx60Hz and 2Jx30Hz). Hard and soft phantom stones were formed, and all tests were conducted in a custom experimental configuration installed in a saline-filled bath. The laser was delivered up to 3 kJ of total energy. The fragmentation pattern was assessed via photographs in each cohort. Results The time to reach the target energy was 5 min and 50 s in all 10 W and 60 W trials, respectively. In both stone types, ablation was more effective when high-power, high-energy and Moses Distance was utilized. In soft stones, the lowest ablation rate was detected in the Long Pulse modality in all power, energy and frequency settings. Overall, when dusting settings (high-frequency, low-energy) were used, a deeper single cavitation was observed rather than small cavitations. Conclusions The most effective pulse modality as evaluated via stone ablation rate depends on the stone hardness as well as energy and frequency settings. In both hard and soft stones, ablation is more effective when 60 W (2Jx30Hz) power settings and Moses Distance are used. Tailored laser settings in terms of energy and frequency could be set for each case scenario.

Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Reply.

Comparison Between Holmium:YAG Laser With MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-Matched Analysis From the FLEXible Ureteroscopy Outcomes Registry. Reply.

Ureteroscopy and lasertripsy with pop dusting using high power holmium laser for large urinary stones > 15mm: 6.5-year prospective outcomes from a high-volume stone center.

Ureteroscopy and stone lasertripsy (URSL) is a recognized technique for treatment of urinary tract stones. Holmium:Yag laser has been successfully used for this purpose for the last two decades. More lately, pulse modulation with Moses technology and high power lasers have been introduced with the result of faster and more efficient stone lasertripsy. Pop dusting is a two-stage combined treatment using a long pulse Ho:YAG laser, initially in contact mode with the stone 'dusting' (0.2-0.5J/40-50Hz) followed by non-contact mode 'pop-dusting' (0.5-0.7J/20-50Hz). We wanted to look at the outcomes of lasertripsy for renal and ureteric stones using a high-power laser machine. Over a period of 6.5years (January 2016-May 2022), we prospectively collected data for patients undergoing URSL for stones larger than 15mm treated using high power Ho:YAG laser (60W Moses or 100W laser). Patient parameters, stone demographics and outcomes of URSL were analyzed. A total of 201 patients, underwent URSL for large urinary stones. In 136 patients (61.6%) stones were multiple and the mean single and cumulative stone size was 18mm and 22.4mm respectively. A pre- and post-operative stent was placed in 92 (41.4%) and 169 (76%) respectively. The initial and final stone free rate (SFR) were 84.5% and 94% respectively and 10% patients underwent additional procedure to achieve stone free status. 7 (3.9%) complications were recorded, all related to UTI/sepsis, with 6 Clavien II and 1 Clavien IVa complication. Dusting and pop-dusting has shown to be successful and safe with the ability to treat large, bilateral or multiple stones with low retreatment and complication rates.

Comparison Between Holmium:YAG Laser with MOSES Technology vs Thulium Fiber Laser Lithotripsy in Retrograde Intrarenal Surgery for Kidney Stones in Adults: A Propensity Score-matched Analysis From the FLEXible Ureteroscopy Outcomes Registry.

We evaluated stone-free rate and complications after flexible ureteroscopy for renal stones, comparing thulium fiber laser and holmium:YAG laser with MOSES technology. Data from adults who underwent flexible ureteroscopy in 20 centers worldwide were retrospectively reviewed (January 2018-August 2021). Patients with ureteral stones, concomitant bilateral procedures, and combined procedures were excluded. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Stone-free rate was defined as absence of fragments >2 mm on imaging within 3 months after surgery. Multivariable logistic regression analysis was performed to evaluate independent predictors of being stone-free. Of 2,075 included patients, holmium:YAG laser with MOSES technology was used in 508 patients and thulium fiber laser in 1,567 patients. After matching, 284 patients from each group with comparable baseline characteristics were included. Pure dusting was applied in 6.0% of cases in holmium:YAG laser with MOSES technology compared with 26% in thulium fiber laser. There was a higher rate of basket extraction in holmium:YAG laser with MOSES technology (89% vs 43%, P < .001). Total operation time and lasing time were similar. Nine patients had sepsis in thulium fiber laser vs none in holmium:YAG laser with MOSES technology (P = .007). Higher stone-free rate was achieved in thulium fiber laser (85% vs 56%, P < .001). At multivariable analysis, the use of thulium fiber laser and ureteral access sheath ≥8F had significantly higher odds of being stone-free. Lasing time, multiple stones, stone diameter, and use of disposable scopes showed significantly lower odds of being stone-free. This real-world study favors the use of thulium fiber laser over holmium:YAG laser with MOSES technology in flexible ureteroscopy for renal stones by way of its higher single-stage stone-free rate.

MP23-13 THERMOGRAPHY-BASED COMPARISON OF DYNAMIC IRRIGATION TEMPERATURES BETWEEN MOSES MODE AND VIRTUAL BASKET MODE: AN IN-VITRO PHANTOM STUDY

You have accessJournal of UrologyCME1 Apr 2023MP23-13 THERMOGRAPHY-BASED COMPARISON OF DYNAMIC IRRIGATION TEMPERATURES BETWEEN MOSES MODE AND VIRTUAL BASKET MODE: AN IN-VITRO PHANTOM STUDY Shimpei Yamashita, Takaaki Inoue, Satoshi Imai, Yasuo Kohjimoto, and Isao Hara Shimpei YamashitaShimpei Yamashita More articles by this author , Takaaki InoueTakaaki Inoue More articles by this author , Satoshi ImaiSatoshi Imai More articles by this author , Yasuo KohjimotoYasuo Kohjimoto More articles by this author , and Isao HaraIsao Hara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003248.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Moses Mode and Virtual Basket Mode are special pulse modulation modes based on Moses technology. However, no previous study has directly compared irrigation temperatures between these two modes. The aim of this in-vitro phantom study was to evaluate the dynamic changes of irrigation temperatures and compare those between these two modes by using thermography. METHODS: We created an unroofed pyelocaliceal model by using silicon flask of 50 mm and filled it with 37°C saline. A flexible ureteroscope (LithoVue) with 200 μm laser fiber was placed in an 11/13 Fr ureteral access sheath inserted into this model. The distance between saline surface and the tip of laser fiber was 5 mm. The laser fired for 60 sec at 0.4 J/60 Hz. Three runs were tested per setting used short pulse mode (SPM), long pulse mode (LPM), Virtual Basket Mode (VBM) (by using 100 W CyberHo, Quanta) and Moses Contact Mode (MM) (by using Pulse 120H, Lumenis). Dynamic changes of irrigation temperatures with and without saline irrigation (25 mL/min) were evaluated by using thermography. We compared the time until 42°C was achieved, the highest reachable temperatures and the area exceeding 42°C among those modes. RESULTS: The time until 42°C was achieved in SPM, LPM, VBM and MM was 19.3 sec, 6.7 sec, 14.3 sec and 9.0 sec, respectively. The time in MM was significantly shorter than that in VBM (p=0.03). On the other hand, the highest reachable temperatures in these modes were respectively 47.4°C, 49.6°C,48.4°C and 48.6°C, and there was no significant difference of temperatures between VBM and MM (p=0.86). Although there was no significant difference of the area exceeding 42°C after laser shot of 15 sec between VBM and MM (17.4% vs 35.5%, p=0.10), the position and spread of high temperature region differed depending on laser modes (Figure). While the area with high temperature spread to the going straight direction of laser in VBM, the area spread also around the ureteroscope as well as the straight direction of laser in MM. CONCLUSIONS: The speed of irrigation temperature rise in MM was faster than that in VBM. Thermography-based evaluation of irrigation temperatures suggested that the irrigation fluid might flow faster in MM than in VBM. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e311 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shimpei Yamashita More articles by this author Takaaki Inoue More articles by this author Satoshi Imai More articles by this author Yasuo Kohjimoto More articles by this author Isao Hara More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-03 A SCRUTINIZED ANALYSIS OF DYSURIA IN THE FIRST WEEKS AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): WHO SHOULD WE BLAME?

You have accessJournal of UrologyCME1 Apr 2023LBA01-03 A SCRUTINIZED ANALYSIS OF DYSURIA IN THE FIRST WEEKS AFTER HOLMIUM LASER ENUCLEATION OF THE PROSTATE (HOLEP): WHO SHOULD WE BLAME? Oswaldo Oliveira Neto, Sabrina Thalita Dos Reis, William C Nahas, Miguel Srougi, and Alberto A Antunes Oswaldo Oliveira NetoOswaldo Oliveira Neto More articles by this author , Sabrina Thalita Dos ReisSabrina Thalita Dos Reis More articles by this author , William C NahasWilliam C Nahas More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and Alberto A AntunesAlberto A Antunes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: After the end of the learning curve, dysuria currently represents the main problem after endoscopic enucleation of the prostate with Holmium Laser (HoLEP). So far, no analysis has actively evaluated its occurrence in the first postoperative weeks and the literature is scarce in defining its risk factors. To evaluate the incidence of dysuria in the first weeks after HoLEP and the main risk factors involved. METHODS: We performed a prospective cohort study with patients diagnosed with benign prostatic hyperplasia (BPH) and undergoing HoLEP. The surgeries were performed by a high skilled surgeon in the method. The occurrence of dysuria was actively evaluated using a Likert scale, where scores from 0 to 3 were classified as mild dysuria and scores from 4 to 10 as moderate to severe dysuria. Patients were assessed weekly. For the analysis of risk factors, we selected 6 categorical clinical variables and 14 continuous clinical variables. For the analysis of categorical variables, we used Fisher's exact and Chi-square tests. For analysis of continuous variables, we used Student's and Mann-Whitney's t tests. The homogeneity of the samples was evaluated using the Levene test. For statistical significance we considered a p<0.05. RESULTS: To date, 23 patients have reached a sufficient follow-up period for the study. The prevalence of moderate to severe dysuria was 66.7% in the first week and 33.3% in the fourth week (Figure 1). In the first week, no variable was relevant in the occurrence of dysuria. At week four, the mean age among patients with moderate to severe dysuria was statistically lower (62.5 vs 68.4 years; p=0.02), and the prevalence of moderate to severe dysuria was statistically higher among patients with a history of preoperative prostate biopsy (66.7% vs 14.3%, p=0.037). Symptom score, prostatic volume, energy density used, surgical time, use of Moses technology, among others, were not related to the intensity of dysuria (Table 1). CONCLUSIONS: When actively and early evaluated, the prevalence of moderate to severe dysuria is significant in the first weeks after HoLEP. Younger patients and cases with a history of prostate biopsy have higher rates of dysuria in the fourth postoperative week. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1176 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oswaldo Oliveira Neto More articles by this author Sabrina Thalita Dos Reis More articles by this author William C Nahas More articles by this author Miguel Srougi More articles by this author Alberto A Antunes More articles by this author Expand All Advertisement PDF downloadLoading ...

Does Moses technology enhance the efficiency and outcomes of regular holmium laser lithotripsy? Results of a pooled analysis of comparative studies.

Holmium laser lithotripsy is currently the optimum standard for surgical treatment of upper urinary calculi. This study aims to evaluate the clinical efficacy and safety of Moses compared with conventional holmium laser lithotripsy for the treatment of patients with upper urinary calculi. We conducted a systematic search using multiple databases (PubMed/Medline, Scopus, Web of Science, and ClinicalTrials.gov) until June 2022. Clinical trials comparing Moses and conventional holmium laser lithotripsy were included. Analysis was performed using RevMan version 5.4.4 software. Four studies with 892 patients were included. There were no significant differences regarding stone-free rate (mean difference [MD] 1.19, 95% CI 0.54, 2.64, p = 0.66), operative time (MD - 9.31, 95% CI - 21.11, 2.48, p = 0.12), fragmentation time (MD - 1.71, 95% CI - 11.81, 8.38, p = 0.74), total energy used (MD 1.23, 95% CI - 0.44, 2.90, p = 0.15), auxiliary procedures (MD 0.38, 95% CI 0.08, 1.90, p = 0.24), and overall complications (odds ratio [OR] 0.70, 95% CI 0.30, 1.66, p = 0.42) between the groups. However, the laser working time (MD - 0.94, 95% CI - 1.20, - 0.67, p < 0.001) of Moses technology was shorter than that of conventional technology. Moses technology has similar outcomes to regular technology in terms of safety and efficacy. Given the higher operating costs of the Moses technology, further study is required to determine whether there are benefits to this new technology.

MOSES technology HoYAG vs Thulium fiber laser for ureteroscopy: When to choose and how to use

MOSES technology HoYAG vs Thulium fiber laser for ureteroscopy: When to choose and how to use

Single-Session Impact of High-Power Laser with Moses Technology for Lower Pole Stones in Retrograde Intrarenal Surgery: Retrospective Study

Background: This study aimed to evaluate the efficacy of a high-power holmium laser with Moses technology (MT) for the treatment of lower pole stones during retrograde intrarenal surgery (RIRS). Methods: Herein, 305 patients with lower pole stones who underwent RIRS using a high-power holmium laser with MT were retrospectively classified into the stone-free (SF) and non-SF groups. We measured the stone burden, stone volume, stone hardness, pre- or post-operative stent placement, infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), and calyceal pelvic height in terms of pelvicalyceal anatomy using retrograde pyelograms and evaluated the predictive factors of postoperative SF. Results: A total of 173 (56.7%) and 229 (75.1%) patients achieved a SF status on postoperative day one and at one month, respectively. Operation time in the SF group was shorter than that in the non-SF group (51.0 vs. 74.5 min). There were no significant differences in postoperative complications between the SF and non-SF groups. Significantly predictive risk factors in postoperative SF included total stone volume (odds ratio (OR), 1.056; 95% CI, 1.015-1.099; p = 0.007), IPA (OR, 0.970; 95% CI, 0.956-0.993; p = 0.009), and IW (OR, 0.295; 95% CI, 0.121-0.718; p = 0.007). The cut-off values of stone volume, IPA, and IW were 515.2 mm3, 46.8°, and 7.75 mm, respectively. Conclusions: A high-power holmium laser with MT in lower pole stones is a valuable option for positive outcomes and patient's safety. Larger stone volume, acute IPA, and narrow IW were negative predictors related to postoperative SF status.

High-Power Holmium with MOSES Technology or Thulium Fiber Laser in MiniPerc with Suction: A New Curiosity.

Purpose: To present initial clinical comparison between high-power holmium laser with MOSES technology (HPH-M) and thulium fiber laser (TFL) during mini-percutaneous nephrolithotomy (PCNL) for renal calculi with specific emphasis on fragmentation efficiency, fragment size distribution, and stone-free rates (SFRs). Materials and Methods: Between August 2018 and December 2019, we performed mini-PCNL for renal calculi <3 cm using HPH-M (Lumenis, Israel) or TFL (Urolase SP, IPG Photonics). Data were collected prospectively in our institutional stone registry. Propensity score matching (1:1) was performed using stone size and density as predictors resulting in matched cohort of 51 patients in each group. Mini-PCNL with active suction sheath was standard across all patients. Primary end-point was SFR at immediate postprocedure and 1 month using CT/kidney, ureter, and bladder radiograph. Stone fragments were retrieved and segregated to assess proportion of dust (<1 mm), small (1-3 mm), and large (>3 mm) fragments. Result: Both groups were comparable in terms of stone size (p = 0.74), volume (p = 0.17), and density (p = 0.69). SFR at 48 hours was 78.43% in HPH-M group and 68.63% in TFL group. Patients with residual fragments were completely clear at 1 month. Lasing time (678.6 vs 551.95 seconds; p = 0.17), stone fragmentation rate (4.6 vs 5.2 mm3/s; p = 0.23), and total laser energy (21.9 vs 16.3 KJ; p = 0.09) were comparable in both arms. Both groups produced similar dusting (46.8 vs 46.41%; p = 0.93). TFL produced a greater proportion of fragments >3 mm (36% vs 22.68%, p = 0.002). On subset analysis based on stone density, all outcome parameters were comparable except a shorter total operative time with TFL (p ≤ 0.05). Conclusion: HPH-M and TFL showed similar SFR. Within constraints of the laser fiber size and energy settings, both modalities were equivalent in terms of fragmentation efficiency and proportion of dusting across stone densities.

Lasers for benign prostatic hyperplasia (hybrid, blue diode, TFL, Moses). Which one to choose?

To present the evidence of latest developments of lasers for the surgical treatment of benign prostatic hyperplasia (BPH). We focused on recent advancements in Ho:YAG laser such as Moses technology, the Thulium Fiber Laser (TFL), the blue diode laser, and hybrid laser. Laser enucleation of prostate techniques using either Ho:YAG laser with the Moses technology and Moses 2.0, or TFL seem efficient and safe compared with the standard enucleation using Ho:YAG laser. Only in vitro studies evaluated the blue diode laser and hybrid laser (combination of a continuous wave TFL and blue diode laser). Blue diode laser showed intermediate incision depth and minimal coagulation depth compared with Ho:YAG laser and Super Pulse TFL. Hybrid laser showed deep incision depth and small coagulation area compared with Ho:YAG laser and continuous wave TFL. Surgical treatment of BPH using Moses technology, Moses 2.0, and TFL shows encouraging results comparable to the standard enucleation using Ho:YAG laser. Only in vitro data are currently available for blue diode laser and hybrid laser. Future well-designed studies comparing these technologies and evaluating them on specific risk groups of patients as well as the long-term durability of outcomes are needed.

Lithotripsy devices for percutaneous nephrolithotomy (PNL) - new developments.

Percutaneous nephrolithotomy (PNL) is the mainstay of surgery for renal calculi>2 cm or complex multiple calculi and is a technique that has been around since 1976. We review recent literature surrounding novel lithotripsy devices and technology used in PNL. At present, the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is widely accepted as the gold standard laser lithotripsy for PNL. SwissLithoClast Trilogy offers a range of probes with a trifecta of electromagnetic, ultrasonic energy with surgeon-controlled suction. The Olympus Shockpulse-SE is a similar lithotripter that relies on continuous ultrasonic energy with pulsed ballistic energy to break stones. Thulium Fiber Laser (TFL) offers an alternative laser energy source to the Holmium laser, which has been shown to be very effective at producing small stone fragments and dust. The Moses technology is another addition in a long list of improvements to the Ho:YAG laser, forming vaporization bubble through which more effective energy can be applied to stones. Trilogy, Shockpulse, TFL and Moses pulse modulation technology for the Holmium laser all provide improvements compared with older lithotripsy devices. In particular, they convey a safer, efficient and more effective way to manage and clear stones.

Comparative effectiveness of high-power holmium laser lithotripsy for pediatric patients with kidney and ureteral stones

The comparative effectiveness of high-power laser technology for kidney stone surgery in pediatric patients is poorly understood. We compared outcomes for the 120W Holmium:yttrium-aluminum-garnet (Ho:YAG) laser with MOSES technology to 30W Ho:YAG laser for pediatric patients undergoing ureteroscopy with laser lithotripsy for kidney and ureteral stones. We evaluated the outcomes of the new MOSES laser technology as compared to low-power Ho:YAG lasers commonly used for kidney stone treatment in the pediatric population. We performed a retrospective cohort study of 131 consecutive patients aged 1-18 years who underwent ureteroscopy and laser lithotripsy for renal and ureteric calculi at a large freestanding children's hospital between 2013 and 2020. The primary outcome was the efficiency quotient, which incorporates stone clearance, auxiliary procedures, and retreatment rates. Outcomes were compared between groups using Chi-square or Fisher's exact tests and multivariable regression. A sensitivity analysis was performed extending the age limit to ≤21 years. Outcomes are summarized in the table below. Median age of the cohort was 14 years with 53% of patients being female. MOSES laser had a higher efficiency quotient and was associated with a lower odds of post-operative emergency department visits (OR 0.2, 95% CI 0.0-1.0; p=0.047). Operative time was similar. In the sensitivity analysis of patients ≤21 years, the statistical significance with fewer emergency department visits was lost and the efficiency quotient was lower. Our results show that stone clearance is similar between the 120W MOSES and 30W Ho:YAG lasers. However, there are indications that high-power laser lithotripsy is more efficient due to fewer auxiliary procedures and a reduction in retreatment. In addition, higher power lasers were associated with fewer emergency department visits. The benefits appear to be greater among children ≤18 years. These exploratory findings are important for pediatric patients due to the requirement for general anesthesia for each procedure and their associated impact on children and their caregivers. High-power laser lithotripsy may be more efficient than lower power laser lithotripsy, which is driven by the fewer auxiliary procedures and reduction in retreatment particularly among youth ≤18 years old.

MP070 - Assessment of stone ablation rates using high and low power lithotripsy with the Moses technology: An experimental study.

MP070 - Assessment of stone ablation rates using high and low power lithotripsy with the Moses technology: An experimental study.

Holmium: yttrium-aluminum-garnet laser with Moses: does it make a difference?

Moses effect is an inherent physical principle of Ho:YAG laser functioning. Moses Technology is a pulse modulation modality of Ho:YAG laser, which became commercially available for the treatment of two urological conditions: urinary stones and benign prostatic obstruction. The purpose of this narrative review is to distinguish between Moses effect and Moses Technology, as well as to summarize the latest evidence on Moses Technology and its main application in the urological field. During laboratory lithotripsy, Moses Technology seems to reduce stone retropulsion and determine higher ablation volume compared with regular lithotripsy. However, this technology presents similar characteristics to long pulse Ho:YAG laser, and several studies showed no significant difference between Moses Technology and standard lasers. When used in prostate enucleation, Moses Technology promises to reduce operating time by increasing the efficiency of prostate resection and improve the hemostasis. Moreover, some studies state that it is possible to reduce the HoLEP morbidity. Despite this, the clinical impact of the time reduction remains uncertain and different studies either present relevant limitations or are burdened by significant bias. Although Moses effect has been extensively described and characterized, and several studies have been published on the usage of Moses Technology for both laser lithotripsy and laser enucleation of the prostate with Holmium YAG, solid clinical evidence on the real improvement of surgical outcomes is still missing.

Laser fiber degradation following holmium laser enucleation of the prostate utilizing Moses technology versus regular mode.

We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550μm standard fibers versus 550μm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level. We prospectively collected outcomes for 50 standardized HoLEP cases using 550μm Moses fiber with 2.0 BPH mode compared to our historical cohort of 50 patients using 550μm standard fibers on regular mode. Macroscopic degradation length was the difference in length of exposed fiber at the start and end of each case. Five consecutive 550μm standard fibers, five 550μm Moses fibers and their respective controls underwent novel utilization of three objective corroborating imaging techniques: Brightfield high resolution microscopy, high resolution 3-D microCT and Confocal Reflection Surface Analysis. Mann-Whitney U, 2-tailed T tests and Chi-squared tests were used. Standard fibers demonstrated greater degradation than the Moses fibers with 2.0 BPH mode [2.9cm (IQR 1.7-4.3cm) vs 0.2cm (IQR 0.1-0.4cm), p < 0.01]. This difference remained significant when comparing degradation per energy used, per minute enucleation and per gram enucleated (all p < 0.05). None of the cases with Moses fiber and 2.0 BPH mode required intraoperative interruption to re-strip the fiber. Objective fiber degradation by three microscopic techniques confirmed more damage to the standard fibers with regular mode. Overall, use of the 550μm Moses fiber with 2.0 BPH mode resulted in less fiber degradation compared to a standard 550μm fiber with regular mode as confirmed using 4 corroborating macroscopic and microscopic techniques.