HoLEP en-bloc with MOSES technology

Steps in the procedure

• 1. Initially, the mucosa is scored circumferentially to demarcate the external sphincter and prostate apex
• 2. The fibers attaching the sphincter to the apex are cut from 3 to 9 o'clock
• 3. Mechanical localization of the plane at the apex bilaterally is then carried out
• 4. The connection of these planes is achieved by cutting the veru frenulum
• 5. Dissection of the posterior plane is then performed defining a clear line of attack
• 6. Attention is then paid to the anterior apex: the white line is deepened by 5 mm, cutting into the prostatic apex, and that allows for a safe anterior apical liberation following the anatomic plane
• 7. After the sphincter is fully released, the line of attack is followed circumferentially until the bladder neck is reached, incised also circumferentially
• 8. The adenoma is then flipped into the bladder for later morcellation

Learning points:

• Development of the Moses technology
• Improvement in morcellation speed
• En-bloc approach with early apical release makes this operation easy to learn, very fast and extremely safe, and prevents early postoperative incontinence

Clinical case:

• 66-year-old patient with a previous medical history of Type II diabetes
• Elevated cholesterol levels, on atorvastatin and metformin
• Bothersome LUTS despite treatment with dutasteride + tamsulosin
• Previous acute retention of urine

Clinical history:

• In ultrasound, the prostate volume was 95 cc
• Flow rate 6.2 mL/second with a prolonged pattern
• PSA 0.68 ng/mL