The Impact of Preoperative Lower Urinary Tract Symptoms Medication on the Functional Performance of Holmium Laser Enucleation of the Prostate

Overview

Journal Cent European J Urol

Specialty Urology

Date 2021 Nov 3

PMID 34729233

Citations 4

Authors

Alexander Tamalunas

Thilo Westhofen

Melanie Schott

Patrick Keller

Michael Atzler

Christian G Stief

Giuseppe Magistro

Affiliations

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Abstract

Introduction: Medical treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) targets prostate size, to prevent disease progression, and prostate smooth muscle tone for rapid relieve of LUTS. Holmium laser enucleation of the prostate (HoLEP) is a size-independent method for surgical treatment of LUTS/BPO in medication-refractory patients and offers durable long-term results with reduced perioperative morbidity. As up to 50% of patients receive medical treatment for LUTS/BPO prior to surgery, we analyzed the impact of alpha-blockers and 5-alpha reductase inhibitors (5-ARI) on outcomes and perioperative morbidity in patients undergoing HoLEP for LUTS.

Material And Methods: We retrospectively gathered data of 1,057 patients, who underwent HoLEP for LUTS/BPO from 2013-2018, and divided patients into group 1 (no medication), group 2 (α-blockers), and group 3 (5-ARI and α-blockers). Perioperative parameters, short-term functional outcomes and safety were assessed and statistical analysis was performed using SPSS V26.0 software.

Results: Even though preoperative LUTS profile was significantly different between groups, all patients improved significantly after HoLEP, irrespective of preoperative LUTS medication. Median improvement of IPSS was 9, 8 and 7 points, of Q was 10, 12 and 9.5 ml/s, with significant improvement of quality of life (QoL) and reduction of post-void residual volume (PVR) for groups 1-3, respectively, 30 days after surgery. With only 4.0% (42/1,057) of patients experiencing a Clavien-Dindo grade ≥II complication, there was no difference in prevalence of perioperative complications between groups (p = 0.943).

Conclusions: Although preoperative LUTS medication does not impair efficacy of HoLEP with acceptable perioperative morbidity, the time gap between medical therapy and surgical treatment may favor an earlier response.

Citing Articles

Phytomedicines in Pharmacotherapy of LUTS/BPH - What Do Patients Think?.

Tamalunas A, Paktiaval R, Lenau P, Stadelmeier L, Buchner A, Kolben T Patient Prefer Adherence. 2024; 18:2507-2518.

PMID: 39678359 PMC: 11645467. DOI: 10.2147/PPA.S484632.

Propensity score-matched evaluation of palliative transurethral resection and holmium laser enucleation of the prostate for bladder outlet obstruction in patients with prostate cancer.

Tamalunas A, Keller P, Schott M, Stadelmeier L, Kidess M, Atzler M Prostate Cancer Prostatic Dis. 2024; 28(1):153-159.

PMID: 38600321 PMC: 11860203. DOI: 10.1038/s41391-024-00831-1.

How does symptom severity impact clinical outcomes of men with lower urinary tract symptoms after holmium laser enucleation or transurethral resection of the prostate?.

Tamalunas A, Schott M, Keller P, Atzler M, Ebner B, Buchner A Cent European J Urol. 2023; 75(4):387-394.

PMID: 36794034 PMC: 9903167. DOI: 10.5173/ceju.2022.161.

Correlation Between Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms and Renal Function in Elderly Men Aged 80 Years and Older.

Wang Q, Zhang B, Li B, Yang S, Wang Z, Han C Clin Interv Aging. 2023; 18:61-69.

PMID: 36660542 PMC: 9844101. DOI: 10.2147/CIA.S392519.

Inhibition of Human Prostate and Bladder Smooth Muscle Contraction, Vasoconstriction of Porcine Renal and Coronary Arteries, and Growth-Related Functions of Prostate Stromal Cells by Presumed Small Molecule Gα Inhibitor, YM-254890.

Tamalunas A, Wendt A, Springer F, Ciotkowska A, Rutz B, Wang R Front Physiol. 2022; 13:884057.

PMID: 35677088 PMC: 9168773. DOI: 10.3389/fphys.2022.884057.

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