LETTERS TO THE EDITOR.

We read with interest the systematic review published by Riveros et al., which has succinctly evaluated the available evidence on Holmium Moses mode. [1]. Their efforts are timely given the continued interest in Moses technology as a means to improve stone lithotripsy. As the authors rightly say, the initial findings from pre-clinical studies were extremely promising. Indeed, many will be familiar with the impressive video demonstrations of Moses technology from benchside models. Combined with the biblical nomenclature, which gives a suggestion of superhuman powers, impressive outcomes in the patient setting were eagerly anticipated. However, Riveros et al. have demonstrated that the reality has not lived up to those expectations. For while Moses mode does appear to hold technical advantages in terms of ablation speed and lasing time, these do not translate to benefits in terms of stonefree status or complication rate. The latter are of course what are most important to the patient, namely, to be free of their stone and to get through their operation without problems. Even operation time was found to have no significant difference in this systematic review [1]. In contrast, other areas of laser technology, such as Thulium fiber laser (TFL) do seem to be able to deliver actual clinical benefit [2]. We would therefore argue that Moses technology has had sufficient time to prove its clinical worth and warrant further research attention. Instead, our focus should be aimed at investigating other areas including TFL, high versus lower power settings, temperature control and single-use ureteroscopes among other key topics where clinically meaningful results can be achieved [3, 4].