Investig Clin Urol.  2020 Jan;61(1):67-74. 10.4111/icu.2020.61.1.67.

Effect of 5α-reductase inhibitors on the efficiency of thulium:yttrium-aluminium-garnet (RevoLix®) vaporesection for treating benign prostatic hyperplasia

• Chung JS
• Seo WI
• Oh CK
• Kim SC
• Park MC
• Park SH
• Yu J
• Lee CH
• Kim W
• Park TY
• Min KS
• Chung JI

• KMID: 2466794
• DOI: http://doi.org/10.4111/icu.2020.61.1.67

Abstract

PURPOSE
Preoperative use of 5α-reductase inhibitors (5ARIs) may cause fibrosis of the prostate tissue and reduce the efficiency of thulium laser surgery for treating benign prostate hyperplasia (BPH). Thus, we investigated the effects of preoperative 5ARI use in this setting.
MATERIALS AND METHODS
This retrospective study examined 184 patients who underwent thulium laser surgery for BPH during 2012-2017. Patients were grouped according to their 5ARI use in order to compare their preoperative and intraoperative characteristics and subsequent outcomes. Surgical efficiency was assessed using vaporesection efficiency. The total operation time, vaporesection time and prostate volume change were measured.
RESULTS
The 5ARI+ group included 83 patients (45.1%) and the 5ARI− group included 101 patients (54.9%). There were no significant differences in the two groups' preoperative characteristics, postoperative prostate size, thulium laser energy use, or prostate volume reduction rate. However, relative to the 5ARI− group, the 5ARI+ group had a significant shorter total operative time (65.0 min vs. 70.0 min, p=0.013) and a significantly shorter vaporesection time (48.0 min vs. 54.0 min, p=0.014), which resulted in significantly higher vaporesection efficiency in the 5ARI+ group (0.66 mL/min vs. 0.51 mL/min, p < 0.001). Both groups exhibit significant improvements in their quality of life score and International Prostate Symptom Score during the 12-month follow-up.
CONCLUSIONS
In contrast with our expectations, the preoperative use of 5ARI increased the efficiency of thulium laser surgery for BPH. Thus, it may not be necessary to stop 5ARI treatment before performing thulium laser surgery in this setting.

Keyword

Laser therapy; Prostatic hyperplasia; Thulium; 5-alpha reductase inhibitors

MeSH Terms

5-alpha Reductase Inhibitors
Fibrosis
Follow-Up Studies
Humans
Hyperplasia
Laser Therapy
Operative Time
Prostate
Prostatic Hyperplasia*
Quality of Life
Retrospective Studies
Thulium
5-alpha Reductase Inhibitors
Thulium

Figure

• 

  Fig. 1 The changes in surgical efficiency depending on the learning curve between the 5ARI(−) and 5ARI(+) groups. (A) Total operation time, (B) laser time, (C) vaporesection time, and (D) vaporesection efficiency. 5ARI, 5α-reductase inhibitor.

• 

  Fig. 2 Preoperative and follow-up urinary symptom and functional outcomes. (A) International Prostate Symptom Score (IPSS), (B) quality of life (QoL) score, (C) maximum flow rate (Qmax), (D) postvoid residual urine volume. 5ARI, 5α-reductase inhibitor.

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