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[Green light laser efficacy in patients with prostatic hyperplasia treatment with 5-alpha reductase inhibitors]
Joaquín Ulises Juan Escudero1, Emilio López Alcina, Macarena Ramos de Campos
1Servicio de Urología, Consorcio Hospital General Universitario de Valencia, Valencia, España. chimojuan@hotmail.com
Introduction:
High prevalence of BPH and gradual ageing of the population, combined with the existence of effective medical treatments for this condition, has led to an increasing use of surgery in patients on long-term treatment with 5-alpha reductase inhibitors (5-ARIs). Initially, patients treated with 5-ARIs were not considered good candidates for photoselective vaporization of the prostate with green laser.
Objective:
To assess, using a retrospective study based on our experience, wheter long-term treatment (longer than 6 months) with 5-alpha reductase inhibitors decreases effectiveness of photoselective vaporization of the prostate with green light laser in BPH.
Materials And Methods:
From September 2005 to January 2008, 102 patients underwent photoselective vaporization of the prostate with green light laser. Of these, 25 patients (24.5%) had been treated with 5-ARIs for at least 6 months, and the remaining 77 patients (75.5%) were used as controls. A retrospective study was conducted to compare the pre- and postoperative clinical and functional parameters of patients with and without prior 5-RAI therapy.
Results:
No statistically significant differences were found between the treated and control groups in preoperative prostatic volume (50 mL vs 49 mL), IPSS (17.6 vs 17.8), postvoiding residue (16% vs 18%), or PSA (1.4 ng/mL vs 2.2 ng/mL). Similarly, while differences were seen in energy spread (180 kJ vs 175 kJ for the treated and control groups respectively) and operating time (63 min vs 57 min), these were not statistically significant. No between-group differences were found either in clinical or flow rate parameters one month after surgery (IPSS 13.8 vs 14 and Qmax 13.9 mL/s vs 14.5 nL/s in the treated and control groups respectively). Surgeons reported a better visualization of the endoscopic field that was attributed to less bleeding during the procedure.
Conclusions:
Our results show no statistically significant differences in peroperative and preoperative parameters between patients with and without treatment with 5-alpha reductase inhibitors. We therefore think that photoselective vaporization of the prostate with green light laser is a safe and effective technique in patients treated with 5-ARIs.
Insights
Long-term treatment with 5-alpha reductase inhibitors (5-ARIs) does not decrease the effectiveness of green light laser vaporization for benign prostatic hyperplasia (BPH). Photoselective vaporization of the prostate is a safe and effective option for BPH patients on 5-ARIs.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Pharmacology
Context:
- Benign prostatic hyperplasia (BPH) is highly prevalent in an aging population.
- 5-alpha reductase inhibitors (5-ARIs) are common medical treatments for BPH.
- Surgical interventions for BPH are increasingly utilized, even in patients on long-term 5-ARI therapy.
Purpose:
- To evaluate the efficacy of photoselective vaporization of the prostate (PVP) using a green light laser in patients with BPH undergoing long-term treatment (over 6 months) with 5-alpha reductase inhibitors (5-ARIs).
- To compare perioperative and postoperative outcomes between BPH patients treated with 5-ARIs and a control group.
Summary:
- A retrospective study compared 25 patients on long-term 5-ARIs with 77 controls undergoing green light laser PVP for BPH.
- No statistically significant differences were observed in preoperative parameters (prostate volume, IPSS, postvoiding residue, PSA) or postoperative outcomes (IPSS, Qmax) between the groups.
- Surgical parameters like energy spread and operating time also showed no significant differences, with surgeons noting improved visualization due to less bleeding.
Impact:
- Photoselective vaporization of the prostate with green light laser is confirmed as a safe and effective procedure for BPH patients, irrespective of prior long-term treatment with 5-alpha reductase inhibitors.
- This finding supports the continued use of green light laser PVP as a viable surgical option for a broader range of BPH patients.
- The study contributes to the understanding of treatment options for BPH in patients with complex medication histories.
