Journal List > Korean J Androl > v.29(2) > 1033075

Park, Kim, Kim, and Park: The Effect of 5-alpha Reductase Inhibitors on the Efficacy of Photoselective Vaporization of the Prostate with 120 W GreenLight HPS Laser

Abstract

Purpose

To evaluate the effect of preoperative 5-alpha reductase inhibitor (ARI) administration on the operative results of photoselective vaporization of prostate with 120W GreenLight HPS laser.

Materials and Methods

Data were collected from 98 benign prostatic hyperplasia (BPH) patients who underwent transurethral electrovaporization of prostate by 120W Greenlight HPS laser between Jan. 2010 and Dec. 2010. We compared the time of operation, the energy required in lasering, postoperative maximum uroflow velocity, change in residual urine volume and complications between 5-ARI administrating group and control group.

Results

56 patients administrated 5-ARI at least 3 months before surgery. 30 and 26 patients administrated finasteride and dutasteride, respectively. Mean follow up period was 4.1±1.8 months. Mean age of the subjects and mean prostate volume were not different. Mean change of postoperative hemoglobin, lasing time and energy required in lasering were greater in 5-ARI administrating group. There were 3 and 1 cases of acute urinary retension in 5-ARI administrating group and control group, respectively.

Conclusions

The mean change of hemoglobin and mean energy required in lasering were greater and mean lasing time was longer in the patients who administrated 5-ARI before photoselective vaporization of prostate by 120W Greenlight HPS laser. Further investigation and extensive study will be needed to confirm these results.

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Table 1.
Preoperative characteristics of the 98 patients
5-ARI group (n=56) Control group (n=42) p-value
Age (yrs) 68.6±6.1 66.3±8.2 0.16
Prostate volume (cc) 42.7±12.7 36.9±16.0 0.08
TZ volume (cc) 22.0±9.1 17.0±13.2 0.07
IPSS 24.4±4.1 24.1±3.6 0.27
QoL 4.6±0.7 4.4±0.6 0.37
PSA (ng/ml) 1.1±3.1 2.0±2.4 0.04
Qmax (ml/s) 11.7±6.1 11.5±7.9 0.87
PVR (ml) 33.5±35.7 48.3±71.3 0.08

5-ARI: 5-alpha reductase inhibitor, TZ: transition zone, IPSS: international prostate symptom score, QoL: quality of life, PSA: prostate-specific antigen, PVR: post void residual.

Table 2.
Operative end point and postoperative outcomes of the 98 patients
5-ARI group (n=56) Control group (n=42) p-value
Operative end point
 ⊿ Hb. (g/dl) 0.53±0.94 0.36±0.90 0.02
 Lasing time (min) 38.4±23.1 27.7±16.0 0.02
 Energy (kJ) 183.3±102.6 124.6±86.2 0.009
 Lasing time/Prostate volume (min/cc) 0.88±0.34 0.74±0.22 0.02
 Lasing time/TZ volume (min/cc) 1.75±0.68 1.61±0.75 0.03
 Energy/Prostate volume (kJ/cc) 4.2±1.8 3.5±1.6 0.07
 Energy/TZ volume (kJ/cc) 9.1±3.4 10.3±7.7 0.39
Postoperative outcomes
 ⊿ Qmax (ml/s) ⊿ PVR (ml) +11.2±1.5 −15.8±13.9 +10.9±1.4 −18.2±16.3 0.53 0.27
 ⊿ IPSS ⊿ QoL −14.0±3.3 −2.1±0.4 −14.2±2.6 −2.0±0.3 0.33 0.17

5-ARI: 5-alpha reductase inhibitor, Hb: hemoglobin, TZ: transition zone, PVR: post void residual, IPSS: international prostate symptom score, QoL: quality of life.

Table 3.
Comparison of preoperative characteristics between finasteride and dutasteride group
Finasteride group (n=30) Dutasteride group (n=26) p-value
Age (yrs) 68.0±8.2 68.8±5.2 0.79
Prostate volume (cc) 44.7±16.1 42.0±11.4 0.63
TZ volume (cc) 24.6±7.7 21.2±9.5 0.32
IPSS 23.9±3.8 24.5±4.0 0.32
QoL 4.5±0.6 4.6±0.7 0.38
PSA (ng/ml) 1.0±0.6 1.0±0.5 0.39
Qmax (ml/s) 9.9±8.1 12.4±5.4 0.44
PVR (ml) 32.6±41.3 33.8±34.8 0.94

TZ: transition zone, IPSS: international prostate symptom score, QoL: quality of life, PSA: prostate-specific antigen, PVR: post void residual.

Table 4.
Comparison of operative end point and postoperative outcomes between finasteride and dutasteride group
Finasteride group (n=30) Dutasteride group (n=26) p-value
Operative end point
 ⊿ Hb (g/dl) 0.52±0.83 0.53±1.0 0.98
 Lasing time (min) 39.5±14.6 38.0±25.6 0.29
 Energy (kJ) 167.1±92.9 189.8±107.3 0.54
 Lasing time/Prostate volume (min/cc) 0.88±0.23 0.90±0.41 0.42
 Lasing time/TZ volume (min/cc) 1.64±0.66 1.78±0.86 0.27
 Energy/Prostate volume (kJ/g) 3.9±2.3 4.1±1.6 0.78
 Energy/TZ volume (kJ/g) 8.3±3.4 9.4±3.4 0.47
 Postoperative outcomes 10.6±2.6 9.7±2.1 0.63
⊿ Qmax (ml/s)
 ⊿ PVR (ml) 15.1±12.2 15.9±11.4 0.72
 ⊿ IPSS 13.9±3.1 14.1±3.3 0.25
 ⊿ QoL 2.1±0.3 2.1±0.4 0.57

Hb: hemoglobin, TZ: transition zone, PVR: post void residual, IPSS: international prostate symptom score, QoL: quality of life.

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