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Medication use and holmium laser prostate surgery: does duration of medication use impact preoperative symptoms and bladder function?

  • Bristol B. Whiles,
  • Stephen P. Pittman,
  • Katie Glavin,
  • Donald Neff,
  • Kerri L. Thurmon

Introduction and objective
Patients with benign prostatic hyperplasia (BPH) commonly take oral medications for their lower urinary tract symptoms. The impact of medication use prior to surgery has not been well described. The purpose of this study is to determine if symptoms and bladder function differ in patients with short vs. long-term medication use prior to undergoing holmium laser prostate surgery. We hypothesized that increased duration of symptoms and medication use may be associated with worse symptoms and poorer bladder function.

In this ongoing prospective observational trial, patients scheduled for holmium laser prostate surgery (enucleation or ablation) completed a preoperative assessment to determine duration of symptoms, medication use, and pre-operative urodynamics. Validated symptom questionnaires were completed prior to surgery. Duration of medication use was separated into two groups (<5 years and >5 years) for our analysis which was completed in SAS Studio utilizing chi-squared and t-tests.

Of the 41 men in our preliminary analysis, mean age was 68.4 ± 6.9 years with a prostate size 105.8 ± 64.1 g. A total of 38 (92.7%) patients were or had previously taken oral medications for BPH symptoms. Duration of medication use was <5 years in 25 (61.0%) patients and >5 years in 16 (39.0%) patients. The mean duration of medication use was 5.0 ± 4.3 years. The most common medications utilized included: 1) Alpha Blockers (92.7%), 2) 5α Reductase Inhibitors (26.8%), 3) Anticholinergics (12.2%). There was no difference in preoperative IPSS, IPSS-Bother, BPH-II, or ICIQ-UI between the two groups (p >0.05). Erectile function was better in patients with shorter duration of medication use (SHIM 15.6 ± 8.5 vs 9.0 ± 7.9; p=0.02). Table 1 contains bladder function parameters, as determined by preoperative urodynamic testing. Detrusor pressure was lower in patients with >5 years of medication use (p=0.03).

Duration of medication use may have long-term effects on bladder function as evidenced by lower detrusor pressure on urodynamics. Further studies are needed to determine if this impacts postoperative outcomes after prostate surgery. Timing of symptom onset may be an important factor in determining the optimal timing for surgery in the future.

Source of Funding

Tags: AUA21