A multiinstitutional study of the effects of medical therapy for lower urinary symptoms on the perioperative outcomes of holmium laser enucleation of the prostate

Jonathan N. Warner, Rafael N. Nunez, Mark D. Tyson, Davis P. Viprakasit, Nicole L. Miller, Mitchell R Humphreys

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: The purpose of this research was to examine the influence of 5ARI and other benign prostatic hyperplasia medical therapies on the perioperative outcomes after holmium laser enucleation of the prostate (HoLEP). During HoLEP, the identification of the planes between the transitional and peripheral zones of the prostate is paramount to the success of the procedure. It has been proposed that delineating the prostate capsule may be more difficult after the use of 5-alpha reductase inhibitor (5ARI) medications. Methods: A retrospective review of patients who underwent HoLEP was performed. Patients were stratified according to their preoperative medication usage. Patient characteristics, pretreatment prostate characteristics and symptom scores, perioperative parameters and complications, and posttreatment symptoms scores were evaluated. Results: There were 176 patients analyzed; 52 (29%) were on no medications, 54 (31%) were on an alpha-blocker (AB) alone, 13 (8%) were on a 5ARI alone, and 57 (32%) were on both a 5ARI and an AB. Enucleation rate (resected volume/resection time) was significantly faster in the combination group. The preoperative prostate-specific antigen value was significantly higher in the 5ARI group. A trend in the lower hemoglobin change was seen favoring the 5ARI group, but this did not reach statistical significance. Evaluating the groups based on the use of 5ARIs either alone or in combination vs no 5ARI confirmed that 5ARI was associated with a significantly faster enucleation rate. Conclusion: Preoperative 5ARI use does not appear to adversely alter the outcomes during HoLEP.

Original languageEnglish (US)
Pages (from-to)1385-1390
Number of pages6
JournalUrology
Volume78
Issue number6
DOIs
StatePublished - Dec 2011

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5-alpha Reductase Inhibitors
Solid-State Lasers
Prostate
Therapeutics
Prostatic Hyperplasia
Prostate-Specific Antigen
Capsules
Hemoglobins

ASJC Scopus subject areas

  • Urology

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A multiinstitutional study of the effects of medical therapy for lower urinary symptoms on the perioperative outcomes of holmium laser enucleation of the prostate. / Warner, Jonathan N.; Nunez, Rafael N.; Tyson, Mark D.; Viprakasit, Davis P.; Miller, Nicole L.; Humphreys, Mitchell R.

In: Urology, Vol. 78, No. 6, 12.2011, p. 1385-1390.

Research output: Contribution to journalArticle

Warner, Jonathan N. ; Nunez, Rafael N. ; Tyson, Mark D. ; Viprakasit, Davis P. ; Miller, Nicole L. ; Humphreys, Mitchell R. / A multiinstitutional study of the effects of medical therapy for lower urinary symptoms on the perioperative outcomes of holmium laser enucleation of the prostate. In: Urology. 2011 ; Vol. 78, No. 6. pp. 1385-1390.
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abstract = "Objective: The purpose of this research was to examine the influence of 5ARI and other benign prostatic hyperplasia medical therapies on the perioperative outcomes after holmium laser enucleation of the prostate (HoLEP). During HoLEP, the identification of the planes between the transitional and peripheral zones of the prostate is paramount to the success of the procedure. It has been proposed that delineating the prostate capsule may be more difficult after the use of 5-alpha reductase inhibitor (5ARI) medications. Methods: A retrospective review of patients who underwent HoLEP was performed. Patients were stratified according to their preoperative medication usage. Patient characteristics, pretreatment prostate characteristics and symptom scores, perioperative parameters and complications, and posttreatment symptoms scores were evaluated. Results: There were 176 patients analyzed; 52 (29{\%}) were on no medications, 54 (31{\%}) were on an alpha-blocker (AB) alone, 13 (8{\%}) were on a 5ARI alone, and 57 (32{\%}) were on both a 5ARI and an AB. Enucleation rate (resected volume/resection time) was significantly faster in the combination group. The preoperative prostate-specific antigen value was significantly higher in the 5ARI group. A trend in the lower hemoglobin change was seen favoring the 5ARI group, but this did not reach statistical significance. Evaluating the groups based on the use of 5ARIs either alone or in combination vs no 5ARI confirmed that 5ARI was associated with a significantly faster enucleation rate. Conclusion: Preoperative 5ARI use does not appear to adversely alter the outcomes during HoLEP.",
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