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EAU 2018: Double-Blinded Prospective Randomized Clinical Trial Comparing Regular and Moses Modes of Holmium Laser Lithotripsy

Copenhagen, Denmark (UroToday.com) Dr. Ibrahim, clinical urologist from the McGill University Health Centre, in Montreal, Canada, presented his center’s experience using the Moses technology for holmium laser lithotripsy. To begin his presentation, Dr. Ibrahim mentioned that previous in vivo and in vitro studies determined that the Moses mode of holmium laser lithotripsy improves fragmentation efficiency, reduced stone repulsion, and shorter operative time in a stone simulator model with artificial stones. Although it has begun to show some success, a randomized clinical trial had never been completed. With that being said, the objective of Dr. Ibrahim and his team was to compare regular and Moses modes of holmium laser lithotripsy in a randomized, double-blinded, prospective study. The endpoints of the study would be the stone fragmentation efficiency and perioperative complication rate for both methods. 

Patients were recruited for this study by screening for those undergoing holmium laser lithotripsy. Patients were randomly assigned to either the control, regular mode or the experimental Moses mode. A Lumenis 120 Watt generator with Moses 200 µ D/F/L fibers were used for all cases. All perioperative data was collected and compared with multivariate analyses. 

Following study completion, a total of 66 patients were recruited with 33 patients in each arm. All patient demographic information was similar between the two cohorts. In regard to fragmentation time, procedural time, and retropulsion grade, the Moses mode was significantly lower when compared to the regular mode of lithotripsy. In fact, there was a 20% reduction in procedure time despite using similar total energy. Intraoperative complications were comparable between the two groups, however, one patient from the Moses cohort suffered ureteral perforation, which was not seen in the regular cohort. Success rates at the end of one month were comparable between cohorts. 

Dr. Ibrahim summarized his presentation by elaborating on the cause of the reduction of procedural and fragmentation times, which he believes is due to the low retropulsion of stones and enhanced efficiency during energy delivery. It is worth mentioning that Lumenis gratuitously provided all fibers used in the study, which may add some potential conflicts of interest to this study.


Presented by: Ibrahim A. MD 

Co-Authors: Fahmy N. , Carrier S. , Elhilali M. , Andonian S.
Author Information: McGill University Health Centre, Dept. of Urology, Montreal, Quebec, Canada

Written by: Zachary Valley MD, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark