Green light laser in patients with prostatic hyperplasia treated with 5-alpha reductase inhibitors

Andrea Fandella1, Stefano Guazzieri1
  • 1 Casa di Cura Giovanni XXIII (Monastier di Treviso)

Objective

20 -30% of patients with benign prostatic hyperplasia ( BPH) are on long-term treatment with 5-alpha reductase inhibitors (5-ARIs). 5 Alpha-reductase inhibitors (5ARIs) reduce angiogenesis in benign prostatic tissue.The modification of the tissue of the prostate by 5-ARIs could alter the action of Green Laser. Our experience patients treated with 5- candidates for photoselective vaporization of the prostate with green laser.
To assess, using a retrospective study based on our experience, whether 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

We sought to determine whether the efficacy and efficiency of 180W GreenLight HPS (American Medical Systems, Inc) laser photoselective vaporization prostatectomy (PVP) is compromised in patients on chronic 5α-reductase inhibitor (RI) therapyFrom 75 patients undergoing Green Laser vaporization of the prostate between November 2012 and February 2015. Their average age, prostate size, and International Prostate Symptom Score (IPSS) were 72.3±7.3 yr, 52.4±34.0ml, and 25.9±4.0, respectively. Of these, 25 patients (33,3%) had been treated with 5-ARIs for at least 6 months, and the remaining 50 patients (66,6%) 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-ARIs 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.

Discussions

One of the major advantages of KTP laser is the blood less nature of this technology. PVP laser vaporization was performed successfully in 66 patients with high cardiopulmonary risk, having presented with an American Society of Anesthesiology score of 3 or greater. In addition, 29 patients were being treated with ongoing oral anticoagulant therapy or had a severe bleeding disorder. No major complication occurred intra-operatively or postoperatively and no blood transfusion was required. Post-operatively, 77% patients did not require irrigation. Average catheterization time was 1.8 ± 1.4 days. Two patients required reoperation due to recurrent urinary retention. Many authors have proposed PVP as a treatment option in men who are at high risk for clinically significant bleeding.

Conclusion

Our experience suggests that 5ARIs do not have a detrimental effect on the efficiency and efficacy of laser PVP. There were no statistically significant differences in peroperative and preoperative parameters between patients with and without treatment with 5-alpha reductase inhibitors.The efficacy and efficiency of PVP with the GreenLight HPS laser are not negatively affected in patients on chronic 5αRI therapy Photoselective vaporization of the prostate with green light laser is a safe and effective technique in patients treated with 5-ARIs.
the only limitations could be the short follow-up lack of a correct hystology in every patients, in fact only in hight risk patients (elevated PSA or elevated PSAv) we take some biopsy at the end of the procedure.

References

Sulser T, Reich O, Wyler S, Ruszat R, Casella R, Hofstetter A, et al. Photoselective KTP laser vaporization of the prostate: First experiences with 65 procedures. J Endourol. 2004;18:976–81. [PubMed]
Alivizatos G, Skolarikos A. Greenlight laser in benign prostatic hyperplasia: Turning green into gold. Curr Opin Urol. 2008;18:46–9. [PubMed]
Reich O, Bachmann A, Siebels M, Hofstetter A, Stief CG, Sulser T. High power (80 W) potassium-titanyl-phosphate laser vaporization of the prostate in 66 high risk patients.
Sandhu JS, Ng CK, Gonzalez RR, Kaplan SA, Te AE. Photoselective laser vaporization prostatectomy in men receiving anticoagulants. J Endourol. 2005;19:1196–8.
Juan Escudero JU, López Alcina E, Ramos de Campos M, Ramada Benlloch F, Sánchez Ballester F, Marqués Vidal E.
Green light laser efficacy in patients with prostatic hyperplasia treatment with 5-alpha reductase inhibitors.Actas Urol Esp. 2009 Oct;33(9):988-93.
Araki M1, Lam PN, Culkin DJ, Wong C.Decreased efficiency of potassium-titanyl-phosphate laser photoselective vaporization prostatectomy with long-term 5 alpha-reductase inhibition therapy: is it true? Urology. 2007 Nov;70(5):927-30

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