Comparative Analysis of Modern Pulse Modulation With MOSES 2.0 and QUANTA 150 Holmium Laser Systems in Laser Enucleation of the Prostate.

OBJECTIVE

Holmium laser enucleation of the prostate (HoLEP) has emerged as a gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). Modern pulse-modulated laser systems aim to improve enucleation efficiency and procedural safety, but no head-to-head comparison has been reported between MOSES 2.0 and QUANTA 150. This study provides a direct comparative analysis of perioperative efficiency and safety between these two technologies.

METHODS

We performed a retrospective analysis of HoLEP procedures performed by a single surgeon between July 2023 and June 2024. Patients were grouped by laser platform (MOSES or QUANTA). The primary outcome was total operative time. Secondary outcomes included enucleation and morcellation parameters, perioperative characteristics, and 30-day outcomes. Multivariable regression models adjusted for age, Charlson comorbidity index, anticoagulant use, and prostate volume were used to control for confounding.

RESULTS

A total of 196 patients were included (132 MOSES, 64 QUANTA). The MOSES cohort had higher comorbidity and anticoagulant use (p < 0.05). After adjustment, QUANTA was associated with significantly shorter total operative, enucleation, laser, and energy times. Morcellation speed was faster with QUANTA (p = 0.034), while absolute morcellation time was comparable (p = 0.08). Enucleation speed was also higher (p = 0.017), and energy efficiency was similar. Site-related workflow differences may have contributed to nonoperative time variation. Postoperative outcomes-including LOS, catheter duration, hematuria, retention, and 30-day events-were similar.

CONCLUSION

Both laser systems demonstrated excellent safety. QUANTA 150 was associated with greater procedural efficiency in this single-surgeon, dual-site experience, underscoring the need for further prospective evaluation across practice settings.