Impact of preoperative 5-alpha reductase inhibitor treatment in holmium laser enucleation of the prostate

Introduction. - The objective of our study is to evaluate the impact of 5-alpha reductase inhibitors (5-ARIs) on perioperative outcomes during HoLEP. Materials and methods. - Between April 2019 and August 2021, we included 151 patients in a monocentric prospective study. Patients were separated into 2 groups depending on whether they took 5-ARIs. For each patient, we collected pre-, peri- and postoperative outcomes. The primary endpoint was to evaluate the impact of 5-ARIs treatment for at least 6 months on perioperative outcomes during HoLEP. Results. - We included 56 patients in group 1 (with 5-ARIs for more than 6 months) and 95 patients in group 2 (without 5-ARIs). The mean weight of adenoma enucleated and weighed by the pathologist was similar in the two groups, 45.1 grams in group 1 versus 51.0 grams in group 2 (P = 0.291). Enucleation time was similar between groups with a mean time of 29.9 minutes (min) in group 1 versus 31.5 min in group 2 (P = 0.428), but we found a significant difference for hemostatic time, which was 2.7 min in group 1 versus 3.6 min in group 2 (P = 0.005), and morcellation time, which was 7.7 min versus 11.8 min (P= 0.021) in favor of group 1. Con-cerning the postoperative outcomes, we did not find any difference between the two groups in terms of length of stay (2.75 days in group 1 versus 2.82 in group 2, P= 0.130). We did not find any difference between the two groups regarding complications. Conclusion. - The use of 5-ARIs could facilitate hemostasis and morcellation. Level of evidence. - III. & COPY; 2022 Published by Elsevier Masson SAS.