Effect of Preoperative Dutasteride on Holmium Laser Enucleation of the Prostate

Abstract

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.

The Natural History of Patients with Prostate Specific Antigen Elevation Receiving Holmium Laser Enucleation of the Prostate: Prospective Cohort Study

“…The fact that 5-ARIs are negatively correlated with PSA is well explained in literature [37]. In our study, we were able to demonstrate that the decrease in PSA postoperatively was consistent with patients not receiving 5-ARI treatment, which is consistent with previously reported studies [34].…”