Green light laser efficacy in patients with prostatic hyperplasia on long-term treatment with 5-alpha reductase inhibitors

Introduction: High prevalence of BPH and gradual ageing of the population, combined with the existence of effective medical treatments for this condition, have 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, whether longterm 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 preoperative and postoperative clinical and functional parameters of patients with and without prior 5-ARI 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), post-void 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 betweengroup 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 mL/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.