MOSES-assisted versus conventional holmium laser enucleation of the prostate for benign prostatic hyperplasia: a pooled study

Abstract

Purpose With the widespread adoption of holmium laser enucleation of the prostate (HoLEP), increasing attention has focused on whether pulse-modulation technologies can further improve procedural efficiency and perioperative outcomes. We therefore conducted an updated systematic review and meta-analysis comparing MOSES-assisted HoLEP (MoLEP) with conventional HoLEP for benign prostatic hyperplasia (BPH). Methods PubMed, Embase, Web of Science, and the ClinicalTrials.gov were searched through September 2026 for comparative studies evaluating MoLEP versus conventional HoLEP. Study selection and data extraction were performed according to predefined criteria. Pooled analyses were conducted using R (version 4.4.1), with subgroup and sensitivity analyses undertaken where appropriate. Results Ten studies comprising 3,177 patients (1,599 MoLEP and 1,578 conventional HoLEP) were included. MoLEP was associated with shorter enucleation time (MD −7.45 min, 95% CI −11.05 to −3.85; P < 0.001), hemostasis time (MD −3.79 min, 95% CI −5.93 to −1.65; P < 0.001), and operative time (MD −12.09 min, 95% CI −18.01 to −6.18; P < 0.001). No significant between-group differences were observed in enucleated weight (MD 1.01 g, 95% CI −3.20–5.21; P = 0.639), catheterization time (SMD −0.13, 95% CI −0.35–0.09; P = 0.238), or length of stay (SMD −0.23, 95% CI −0.52–0.05; P = 0.113). MoLEP was associated with a generally lower incidence of postoperative complications than conventional HoLEP ( P < 0.001). Regarding functional outcomes, statistically significant between-group differences were observed in PVR at 1 and 6 months, QoL at 3 months, and IPSS at 6 months, whereas other functional outcomes did not differ significantly between groups. Conclusions The current evidence suggests that MoLEP may improve perioperative efficiency and reduce postoperative complications, while early functional outcomes remain broadly comparable with conventional HoLEP. Further high-quality studies with longer follow-up are needed to confirm these potential benefits. Systematic Review Registration ID: CRD420251177474.