A Focused Review on the Effects of Preoperative 5α-Reductase Inhibitors Treatment in Patients Undergoing Holmium Laser Enucleation of the Prostate: What Do We Know So Far?

Dimopoulos, Panagiotis; Christopoulos, Panagiotis; Kampantais, Spyridon

doi:10.1089/end.2017.0734

Cited by 6 publications

(6 citation statements)

References 16 publications

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“…Clinical guidelines for BPH [7] describe the definitive indications for surgical managements, considering this a benign disease. The backgrounds of the patients undergoing surgical management are varied, just as the duration of medical treatments, including dutasteride, are also varied [8].…”

Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

et al. 2019

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KeywordsHoLEP · YAG laser · 5α-reductase inhibitor dosing · Surgery-related complications Abstract Purpose: The aim of this study was to compare and investigate the efficacy of using the 5α-reductase inhibitor dutasteride after holmium laser enucleation of the prostate (HoLEP) to improve postoperative urination and surgeryrelated complications. Methods: This is a retrospective observational study comparing patients who received or did not receive 5α-reductase inhibitors prior to HoLEP. Of a total of 270 patients, 40 received the 5α-reductase inhibitor dutasteride. We compared the factors including age, postoperative maximal flow rate (MFR; mL/s), postoperative prostate-specific antigen (PSA) (ng/mL), preoperative MFR (mL/s), preoperative PSA (ng/mL), prostate cancer (%), operative time (min), preoperative residual urine (mL), postoperative residual urine (mL), urinary incontinence (day 1; %), urinary incontinence (1 month; %), urinary incontinence (3 months; %), urethral catheter indwelling period (days), morcellation time (min), enucleation time (min), intraoperative complications (%), postoperative complications (%), pros-tate volume (mL), enucleated weight (g), and hospitalization period (days). Results: Postoperative PSA (p = 0.0071), morcellation time (p = 0.0444), postoperative complications (p = 0.0350) and prostate volume (p = 0.0069), but not enucleated prostate weight (p = 0.8809), were significantly lower in the dutasteride group. Importantly, enucleation efficiency and morcellation efficiency did not show any significant difference between the dutasteride and the nondutasteride groups. Conclusions: Use of a preoperative 5α-reductase inhibitor significantly correlated with surgeryrelated factors, with less morcellation time, fewer postoperative complications, and lower postoperative PSA. Surgeons performing HoLEP may wish to take these findings into account.

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Section: Discussionmentioning

confidence: 99%

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

et al. 2019

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“…Trials focused on fibrotic changes of the prostate during 5ARI therapy have confirmed a transforming growth factor-β (TGF-β) concentration increase [30][31]. These fibrotic changes are important because they may cause an increased degree of difficulty in identifying and maintaining the appropriate plane on the surgical capsule of the prostate during transurethral enucleation techniques [22].…”

Section: Agingmentioning

confidence: 99%

“…However, less data is available concerning the effect of pretreatment with finasteride or dutasteride in patients undergoing HoLEP. Initial reports suggest that they are less successful than for traditional transurethral surgery; microvascular density (MVD) decreases significantly but perioperative bleeding does not differ from control groups [21][22][23].…”

mentioning

confidence: 99%

Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

Busetto

Giudice

Maggi

et al. 2020

Aging

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Benign prostate enlargement, with related lower urinary tract symptoms (LUTS), is one of the most common diseases for patients who are referred to a urologist. Benign prostate enlargement strongly impacts quality of life and is accompanied by a substantial economic burden [1-2]. Disease management is initially based on watchful waiting and medical therapy. In particular α-blockers are able to increase International Prostate Symptom Scores

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“…Nevertheless, previous studies have demonstrated that 5ARI use did not influence the efficiency of PVP surgery [12][13][14]. It is also possible that 5ARI use may increase the difficulty and decrease the effectiveness of HoLEP surgery, which requires precise identification of the prostate capsule or the interface between the transition and peripheral zones, although conflicting results have been reported regarding the effect of 5ARI use in this setting [7,[15][16][17].…”

Section: Effect Of 5α-reductase Inhibitors On the Efficiency Of Thulium:yttrium-aluminium-garnet (Revolix®) Vaporesection For Treating Bementioning

confidence: 94%

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

Chung

Seo

et al. 2020

Investig Clin Urol

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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.

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A Focused Review on the Effects of Preoperative 5α-Reductase Inhibitors Treatment in Patients Undergoing Holmium Laser Enucleation of the Prostate: What Do We Know So Far?

Abstract: Overall, 5-ARIs do not seem to affect HoLEP. However, the quality of evidence is still quite poor in comparison with other surgical techniques. Further well-designed studies are required before making any definite recommendations on the use of 5-ARIs in patients undergoing HoLEP.

Cited by 6 publications

References 16 publications

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

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

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