Comparison of the efficacy and safety of holmium laser with the Moses technology and regular mode for stone treatment: a systematic review and meta-analysis

Background: As a new pulse modality of holmium laser in retrograde intrarenal stone surgery, the MOSES technique can reduce the possibility of stone drifting and help to powder kidney stones in vitro and in animal experiments. However, there remains controversy about whether the MOSES mode needs to be used instead of the regular mode in clinical practice. This meta-review was conducted to evaluate the clinical efficacy and safety of MOSES technology for stone disease.

Methods: PubMed, Embase, Web of Science, Cochrane Library, and CNKI were searched for relevant studies until September 2022, with 1 RCT and 6 nonrandomized studies included. We pulled data on adverse events, success rates and operative time to analyze based on the random effect model.

Results: We found that using MOSES mode could shorten the operative time (standard mean difference [SMD] - 0.43; 95% confidence interval [CI] - 0.79 to - 0.08; P = 0.016) than regular mode especially in a small sample study or in the Asian area. When the number of women is smaller than the number of men, the reduction of the duration was also significant. Stone-free rates of the two modes had no difference (relative risk [RR] 1.06; 95% CI 0.99-1.12; P = 0.30), and there was no publication bias. In terms of safety, no significant difference in complications was detected between the two approaches (RR 0.85; 95% CI 0.48-1.53; P = 0.81) without significant heterogeneity.

Conclusion: MOSES mode holmium laser was superior to the regular mode laser in terms of procedure time. There was no large disparity in stone-free rates or complications between the two modes. However, our conclusions should be confirmed in prospective studies with high evidence.