Open Access

ARTICLE

The impact of 5-ARI on perioperative and functional outcomes of GreenLight PVP: an analysis of the Global GreenLight Group database

Tawfik Elsherbini^1,*, David Bouhadana^2,*, Iman Sadri³, David-Dan Nguyen⁴, Kyle W. Law⁵, Adel Arezki³, Claudia Deyirmendjian¹, Ahmed Ibrahim⁵, Naeem Bhojani⁵, Dean S. Elterman⁶, Bilal Chughtai⁷, Franck Bruyère⁸, Luca Cindolo⁹, Giovanni Ferrari⁹, Carlos Vasquez-Lastra¹⁰, Tiago Borelli-Bovo¹¹, Edgardo F. Becher¹², Hannes Cash¹³, Maximillian Reimann¹⁴, Enrique Rijo¹⁵, Vincent Misrai¹⁶, Kevin C. Zorn⁵

1 Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
2 Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
3 Division of Urology, McGill University, Montreal, Quebec, Canada
4 Division of Urology, University of Toronto, Toronto, Ontario, Canada
5 Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada
6 Division of Urology, University Health Network, Toronto, Ontario, Canada
7 Department of Urology, Weill Cornell Medical College, New York, New York, USA
8 Department of Oncology and Urology, Centre Hospitalier Universitaire de Tours, Centre-Val de Loire, France
9 Department of Urology, Hesperia Hospital, “Cure Group”, Modena, Italy
10 Department of Urology, ABC Medical Center, Mexico City, Mexico
11 Borelli Urologia, Ribeirão Preto, Sao Paulo, Brazil
12 Centro de Urologia, CDU, Buenos Aires, Argentina
13 Prouro, Urology Berlin, Berlin, Germany and Department of Urology, University of Magdeburg, Magdeburg, Germany
14 Department of Urology, Charite – Universitaetsmedizin Berlin, Berlin, Germany
15 Department of Urology, Hospital Quiron Barcelona, Barcelona, Spain
16 Department of Urology, Clinique Pasteur, Toulouse, France
Address correspondence to Dr. Kevin C. Zorn, 1051 rue Sanguinet, Montreal, QC H2X 3E4 Canada

Canadian Journal of Urology 2023, 30(2), 11473-11479.

Abstract

Introduction: In this study, we sought to investigate the impact of 5-alpha reductase inhibitors (5-ARI) on the perioperative and functional outcomes of 180-Watt XPS GreenLight photovaporization of the prostate (PVP) using a large international database.
Materials and methods: Data were obtained from the Global GreenLight Group (GGG) database, which includes eight high-volume, experienced surgeons from seven international centers. All men with established benign prostatic hyperplasia (BPH) with known 5-ARI status who underwent GreenLight PVP using the XPS-180W system between 2011 and 2019 were eligible for the study. Patients were assigned to two groups based on the preoperative use of 5-ARI. Analyses were adjusted for patient age, prostate volume, and American Society of Anesthesia (ASA) score.
Results: We included 3,500 men, of which 1,246 (36%) had preoperative 5-ARI use. Patients in both groups were similar with regards to age and prostate size. On multivariable analysis, total operative time was slightly shorter (-3.26 min 95% CI: 1.20 — 5.32, p < 0.01) and required 35.6kJ less laser energy (95% CI: -48.0kJ — -23.3kJ, p < 0.01) for patients on 5ARI compared to those without 5-ARI. However, no clinically significant difference was appreciated regarding postoperative transfusion rates [OR 0.048 (95% CI -0.82-0.91; p = 0.91)], hematuria rates [OR 0.96 (95% CI 0.72-1.3; p = 0.81)], 30-day readmission rates [OR 0.98 (95% CI 0.71-1.4; p = 0.90)], or overall functional outcomes.
Conclusion: Our findings suggest that preoperative 5-ARI is not associated with any clinically significant different perioperative or functional outcomes for GreenLight PVP using the XPS-180W system. There is no role for the initiation or discontinuation of 5-ARI prior to GreenLight PVP.

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