title: A multiinstitutional study of the effects of medical therapy for lower urinary symptoms on the perioperative outcomes of holmium laser enucleation of the prostate.
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.
  
  
  CONCLUSIONS
  Preoperative 5ARI use does not appear to adversely alter the outcomes during HoLEP.
authors.affiliation: Department of Urology, Mayo Clinic, Phoenix, AZ 85054, USA. warner.jonathan@mayo.edu
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Warner
authors.forename: Rafael N
authors.initials: RN
authors.lastname: Nunez
authors.forename: Mark D
authors.initials: MD
authors.lastname: Tyson
authors.forename: Davis P
authors.initials: DP
authors.lastname: Viprakasit
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Mitchell R
authors.initials: MR
authors.lastname: Humphreys
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D004359:Drug Therapy, Combination; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D053448:Prostatism / Q000188:drug therapy* / Q000209:etiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics / Q000187:drug effects
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists; D017430:Prostate-Specific Antigen