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

Mark A. Assmus, Matthew S. Lee, Mayandi Sivaguru, Deepak K. Agarwal, Tim Large, Bruce W. Fouke, Amy E. Krambeck

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


PURPOSE: We sought to objectively compare laser fiber degradation for holmium laser enucleation of the prostate (HoLEP) cases performed with 550 μm standard fibers versus 550 μm Moses 2.0 fiber in BPH mode on a macroscopic and microscopic level.

METHODS: We prospectively collected outcomes for 50 standardized HoLEP cases using 550 μm Moses fiber with 2.0 BPH mode compared to our historical cohort of 50 patients using 550 μm 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 550 μm standard fibers, five 550 μm 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.

RESULTS: Standard fibers demonstrated greater degradation than the Moses fibers with 2.0 BPH mode [2.9 cm (IQR 1.7-4.3 cm) vs 0.2 cm (IQR 0.1-0.4 cm), 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.

CONCLUSION: Overall, use of the 550 μm Moses fiber with 2.0 BPH mode resulted in less fiber degradation compared to a standard 550 μm fiber with regular mode as confirmed using 4 corroborating macroscopic and microscopic techniques.

Original languageEnglish (US)
Pages (from-to)1203-1209
Number of pages7
JournalWorld Journal of Urology
Issue number5
StatePublished - May 2022
Externally publishedYes

Bibliographical note

Funding Information:
We thank the MRL-UIUC facility for the Confocal Reflection analysis and IGB Microscopy Core facility for the micro-CT and Axiozoom V16 analysis.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


  • BPH
  • Fiber degradation
  • HoLEP
  • Holmium laser
  • Humans
  • Transurethral Resection of Prostate
  • Male
  • Treatment Outcome
  • Prostate/surgery
  • Prostatic Hyperplasia/surgery
  • Laser Therapy/methods
  • Technology
  • Holmium
  • Lasers, Solid-State/therapeutic use

PubMed: MeSH publication types

  • Journal Article


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