PD26-03 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON ENUCLEATION AND MORCELLATION EFFICIENCY DURING HOLMIUM LASER ENUCLEATION OF THE PROSTATE

Abstract

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology I1 Apr 2014PD26-03 IMPACT OF 5-ALPHA REDUCTASE INHIBITORS ON ENUCLEATION AND MORCELLATION EFFICIENCY DURING HOLMIUM LASER ENUCLEATION OF THE PROSTATE Marawan M. El Tayeb, Naeem Bhojani, Jessica A. Mandeville, Ronald S. Boris, Lori D. Rawlings, Kimberly J. Smoot, and James E. Lingeman Marawan M. El TayebMarawan M. El Tayeb More articles by this author , Naeem BhojaniNaeem Bhojani More articles by this author , Jessica A. MandevilleJessica A. Mandeville More articles by this author , Ronald S. BorisRonald S. Boris More articles by this author , Lori D. RawlingsLori D. Rawlings More articles by this author , Kimberly J. SmootKimberly J. Smoot More articles by this author , and James E. LingemanJames E. Lingeman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2090AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The prostate is composed of approximately 70% glandular elements and 30% fibromuscular stroma. 5-alpha reductase inhibitors (5ARIs) are a commonly prescribed medication for BPH that reduces prostate volume by causing regression of the soft glandular element of the gland resulting in a greater % of the fibromuscular stromal element. HoLEP is an effective treatment for benign prostatic hyperplasia (BPH) that involves removal of the transitional zone. Due to the large volume of tissue accumulated during enucleation, morcellation is required for specimen removal. Enucleation and morcellation times are dependent on a number of factors including prostate volume as well as tissue quality. We hypothesized that patients taking 5ARIs prior to HoLEP may have longer surgeries secondary to a more challenging enucleation and/or morcellation due to the effect of these drugs on prostatic tissue. Factors potentially impacting tissue enucleation and morcellation were analyzed. METHODS A retrospective single institution analysis of HoLEP patients between 1998 and 2011 was performed. Variables that may impact enucleation and morcellation times were evaluated using univariate and multivariate linear regression models. RESULTS Overall, of 714 patients who underwent HoLEP, 222 or 31.1% of patients were taking a 5ARI (Table 1). After univariate and multivariate analysis, only the weight of the specimen that was removed was found to be predictive of enucleation and morcellation times (Tables 2 and 3). More specifically, with increasing prostate size there was a statistically significant increase in both enucleation and morcellation times. CONCLUSIONS On multivariate analysis only specimen weight significantly predicts enucleation and morcellation times. The use of 5ARIs as a predictor of enucleation and/or morcellation times was not found to be statistically significant. Table 1: Holmium laser enucleation of the prostate: patient characteristics 5 ARI (-) absent 5 ARI absent p N 492 222 Age (years) 70.6 (34-95) 70.3 (48-90) 0.6 PSA 7.7 (0.04-143.7) 6.9 (0.1-48) 0.3 Mean enucleation time (min) 67.1 (10-245) 66.2 (11-169) 0.7 Mean enculeation rate (g/min) 1.3 (0.01-8.1) 1.6 (0.2-5.1) 0.001 Mean morcellation time (min) 18.8 (0-260) 20.8 (0-91) 0.2 Mean morcellation rate (g/min) 5.5 (0.6-31.5) 5.6 (0.5-19.3) 0.8 Mean prostate weight (g) 80.0 (0.2-390.0) 94.7 (4.0-532.2) 0.001 Presence of cancer 50 18 Table 2: Univariate and multivariate analysis predicting enucleation and morcellation time Enucleation time Morcellation time Univariate Age 0.07 (p=0.05) 0.12 (p=0.001) PSA 0.10 (p=0.007) 0.24 (p<0.001) 5ARI -0.01 (p=0.7) 0.05 (p=0.2) Duration of 5ARI -0.01 (p=0.8) 0.02 (p=0-.7) Weight of specimen 0.3 (p<0.001) 0.7 (p<0.001) Presence of cancer -0.08 (p=0.04) -0.07 (p=0.06) Multivariate Age 0.04 (p=0.3) 0.02 (p=0.4) PSA -0.02 (p=0.6) -0.02 (p=0.4) 5ARI -0.05 (p=0.2) -0.04 (p=0.2) Weight of specimen 0.3 (p<0.001) 0.7 (p<0.001) Presence of cancer -0.05 (p=0.2) -0.005 (p=0.8) © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e759 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marawan M. El Tayeb More articles by this author Naeem Bhojani More articles by this author Jessica A. Mandeville More articles by this author Ronald S. Boris More articles by this author Lori D. Rawlings More articles by this author Kimberly J. Smoot More articles by this author James E. Lingeman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...