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

  • 1Department of Urology, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 2Department of Urology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
  • 3Department of Urology, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.


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.
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.
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.
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.


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

MeSH Terms

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


  • 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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