The effect of dutasteride on the efficacy of photoselective vaporization of the prostate: results of a randomized, placebo-controlled, double-blind study (DOP trial).

OBJECTIVES: To study the effect of Dutasteride on the efficacy of GreenLight photoselective vaporization of the prostate (PV). Some investigators have suggested that 5 alpha-reductase inhibitors may interfere with PV by reducing intraprostatic blood flow. Dutasteride offers the most complete blockade of the 5 alpha-reductase inhibitors, with minimal increase in side effects. METHODS: This is a prospective, placebo-controlled, randomized, double-blind study. A total of 59 patients were randomized to either dutasteride 0.5 mg or placebo for 3 months before and 12 months after PV. Surgical time, joules used, estimated blood loss, and ease of the procedure were compared. Other clinical end points investigated include postsurgical catheter time, hematuria, dysuria, urinary flow parameters, American Urological Association symptom score, benign prostatic hyperplasia quality of life score, prostate volume, and prostate-specific antigen level. RESULTS: Average surgical time and joules used were 12% (P = .24) and 16% (P = .15) less, respectively, for dutasteride patients compared with placebo. Estimated blood loss was also lower in the treatment group (P = .14). However, these results were not statistically significant. Surgeon-rated ease of the procedure was comparable between the 2 groups. There were no significant differences in catheter time, dysuria, quality of life scores, or urinary flow parameters. Quality of life and urinary parameters markedly improved after PV. CONCLUSIONS: Compared with patients randomized to placebo, patients randomized to dutasteride experienced a trend toward decreased time, joules used, and blood loss during surgery. Although we could not convincingly prove an operative benefit of treatment with dutasteride before surgery, we have demonstrated the efficacy of PV in men receiving dutasteride.

Urodynamic changes and initial results of the AdVance male sling.

OBJECTIVES: To present the urodynamic changes and early results associated with the AdVance male sling. The AdVance male sling is a treatment option for postprostatectomy incontinence (PPI), with the goal of eliminating urinary incontinence without affecting voiding parameters. A concern of any procedure in treating men with PPI is whether the treatment induces obstruction and causes retention. METHODS: Data were prospectively collected from 13 patients undergoing AdVance male sling placement for PPI. Urodynamic testing was performed at baseline and repeated at 6 months postoperatively. A 24-hour pad test and the Incontinence Quality of Life questionnaire were completed preoperatively and at 3 and 6 months postoperatively. RESULTS: The median age at the procedure was 63.3 years (range 44.7-74.7). The mean preoperative and 6-month postoperative patient-reported pad use was 4.52 and 1.04, respectively (2-tailed t test, P = .0009). The 24-hour pad test, performed preoperatively and at 6 months postoperatively, yielded a pad weight of 779.3 and 67.6 g, respectively (P = .03). The Valsalva leak point pressure improved significantly (P = .032), but the detrusor voiding pressure, postvoid residual urine volume, and maximal and average flow rates remained relatively unchanged. At 3 and 6 months postoperatively, the Incontinence Quality of Life scores had improved significantly compared with the preoperative scores (P <.01). CONCLUSIONS: These results are encouraging, because this series has demonstrated a significant improvement in patient-reported pad use, 24-hour pad test weights, and Valsalva leak point pressure without signs of obstruction. The improvement in incontinence was accompanied without any changes in the other voiding parameters and with significant improvement in the quality-of-life measures. Ongoing studies with longer follow-up are pending to compare their results with these promising early results.