Impact of 5-alpha reductase inhibitors on functional outcomes of GreenLight photovaporization of the prostate (PVP): An analysis of 3500 men in the Global GreenLight Group (GGG) database
Iman Sadri1, David-Dan Nguyen2, Kyle Law3, Adel Areki2, David Bouhadana2, Naeem Bhojani3, Dean Elterman4, Ahmed S. Zakaria5, Franck Bruyère6, Luca Cindolo7, Giovanni Ferrari7, Carlos Vasquez-Lastra 8, Tiago Borelli-Bovo 9, Edgardo F Becher10, Hannes Cash11, Maximillian Reimann11, Enrique Rijo12, Vincent Misrai13, Kevin Zorn3.
1Division of Urology, McGill University Health Centre, Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC, Canada; 4Division of Urology, University Health Network, Toronto, ON, Canada; 5Division of Urology, Northern Ontario School of Medicine, Thunder Bay, ON, Canada; 6Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Tours, France; 7Department of Urology, Hesperia Hospital, Modena, Italy; 8Department of Urology, ABC Medical Center, Mexico City, , Mexico; 9Borelli Urologia, Ribeirão Presto, Sao Paulo, Brazil; 10Centro de Urologia, CDU, Buenos Aires, Argentina; 11Department of Urology, Charité – Universitaetsmedizin Berlin, Berlin, Germany; 12Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain; 13Department of Urology, Clinique Pasteur, Toulouse, France
Introduction: 5-alpha reductase inhibitors (5-ARIs) are an effective medical therapy for patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Furthermore, they can cause alterations in various prostate tissue parameters. We sought to investigate the impact of 5-ARIs on the operative outcomes of 180W XPS GreenLight photovaporization of the prostate (PVP) using a large international database.
Methods: Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from a total of seven international centers. All men with established BPH with known 5-ARI status who underwent GreenLight PVP (GL) using the XPS-180W system between 2011 and 2019 were eligible for the study; 3500 men were identified. Patients were assigned to one of two groups based on 5-ARI status prior to surgery. Data were adjusted for patient age, prostate volume, and American Society of Anesthesiolgist score.
Results: Patients in both groups were similar with regards to age and prostate size (Figure 1, Table 1). Patients taking 5-ARIs had significantly higher baseline International Prostate Symptom Score and quality of life scores, in addition to significantly lower preoperative maximal flow rate and prostate-specific antigen levels. On univariate analysis (Table 2), men taking 5-ARIs required shorter hospital stays (p<0.01), and a lower risk of requiring a blood transfusion (rate of 0.79% vs. 0.86%, respectively, p=0.04). Furthermore, there were no statistically significant changes in total operative time, laser time, or readmission rates. On multivariate analysis, total operative time was 3.26 minutes shorter (95% confidence interval [CI] 1.20–5.32, p<0.01) and 35.6 kJ less laser energy (95% CI -48.0kJ–-23.3kJ, p<0.01) was required for patients on 5-ARI. No significant difference was appreciated with regards to postoperative transfusion rates, readmission rates, or overall functional outcomes.
Conclusions: Our findings suggest that preoperative 5-ARI decreases operative time and total laser energy required, with minimal changes to postoperative outcomes for patients undergoing GL using the XPS-180W system.
