Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride
Sørlandet Hospital, Arendal, Aust-Agder, Norway BJU International
(Impact Factor: 3.53).
04/2007; 99(3):587-94. DOI: 10.1111/j.1464-410X.2006.06619.x
To determine whether pretreatment with dutasteride, a dual 5alpha-reductase inhibitor (5ARI), reduces surgical blood loss or postoperative complications in patients with benign prostatic hyperplasia (BPH) who undergo transurethral resection of the prostate (TURP).
This double-blind, randomized, placebo-controlled, multicentre study comprised 214 patients with BPH. Placebo was compared with dutasteride 0.5 mg/day 2 weeks before and after TURP, or 4 weeks before and 2 weeks after TURP. Surgical blood loss was measured using a haemoglobin photometer (HemoCue AB, Angelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips.
Although dutasteride reduced serum dihydrotestosterone (DHT) by 86-89% in 2-4 weeks, and intraprostatic DHT was approximately 10 times lower than in the placebo group, the (adjusted) mean haemoglobin (Hb) loss during surgery was 2.15-2.55 g Hb/g resectate with no significant difference in blood loss between the groups either during or after TURP. Clot retention occurred in 6-11% and urinary incontinence in 14-15% of patients during the 14 weeks after TURP, with no difference between the groups. The MVD at TURP was also similar for all groups.
There were no significant reductions in blood loss during or after TURP or complications afterward with dutasteride compared with placebo, despite significant suppression of intraprostatic DHT. Blood loss and transfusion rates in the placebo group were lower than those previously reported in studies where there was a beneficial effect of a 5ARI, relative to placebo, on bleeding during TURP.
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- "The irrigant return should be heparinised during the procedure by adding 1500 IU of heparin/8 L of irrigant return, then uniformly mixed to prevent coagulation of the blood contents. The blood loss was then calculated as reported previously  , i.e., the preoperative haemoglobin concentration, minus that in the irrigant return (g/dL) · volume (L) · 1000. The rate of blood loss (amount of blood loss/resection time) and the amount of blood lost/g of resected tissue were also calculated . "
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ABSTRACT: To evaluate the efficacy and safety of bipolar transurethral resection of the prostate (TURP) in patients with a large prostate (>90 g), as a significant recent modification of TURP is the incorporation of bipolar technology, which uses the same technique as monopolar TURP but with normal saline as the irrigant.Patients and methodsForty patients with a prostate of >90 g and who were considered at risk for monopolar TURP were treated by bipolar TURP. The operative duration, resection time, resected tissue weight, resection rate, resection ratio, amount of irrigation fluid used, the decrease in intraoperative haemoglobin level, haematocrit and serum sodium levels, and the blood loss were recorded. The follow-up data were analysed.ResultsThe mean (SD) operative duration was 116.3 (25.52) min, the resection time was 106.5 (25.69) min, the resected volume was 78.9 (20.58) g, the decrease in haemoglobin levels was 1.67 (0.46) g/dL, the mean serum sodium decline was 2.60 (0.68) mmol/L, and the blood loss was 532 (101.2) mL. The blood loss/g of resected tissue was 6.85 (0.70) mL. The mean (SD) postoperative bladder irrigation time was 2.0 (0.32) days, the catheterisation time was 3.25 (0.55) days and the postoperative hospital stay was 3.25 (0.55) days.Conclusion
Bipolar technology makes it possible to use TURP to treat patients with very large prostates and who are at risk when treated by the standard monopolar technology, with a satisfactory safety profile and with favourable efficacy.
Available from: europepmc.org
- "Investigators who conducted prospective randomized trials in Denmark concluded that finasteride does not reduce perioperative bleeding during TURP . Additionally, Hahn et al. , who conducted a double-blind, randomized, placebo-controlled, multicenter study, reported that pretreatment with 0.5 mg dutasteride for 2 or 4 weeks before TURP did not reduce blood loss during the surgery. The AUA panel concluded that there is unsatisfactory evidence to propose 5-ARIs pretreatment for preventing intraoperative or postoperative prostate bleeding . "
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ABSTRACT: The key enzyme in the androgen synthesis and androgen receptor pathways is 5α-reductase (5-AR), which occurs as three isoenzymes. Types I and II 5-ARs the most important clinically, and two different 5-AR inhibitors (5-ARIs), finasteride and dutasteride, have been developed. Several urology associations have recommended and upgraded the use of 5-ARIs for an enlarged prostate with lower urinary tract symptoms. In the Prostate Cancer Prevention Trial and the Reduction by Dutasteride of Prostate Cancer Events Trial, 5-ARIs reduced the incidence of low-grade prostate cancer. However, despite the documented reductions in the overall incidence of prostate cancer, 5-ARIs are at the center of a dispute. The American Society of Clinical Oncology (ASCO) and the American Urology Association (AUA) presented clinical guidelines for the use of 5-ARIs for chemoprevention of prostate cancer in 2008. However, ASCO/AUA has eliminated these from the main "Clinical Guidelines" in 2012, because the U.S. Food and Drug Administration denied a supplemental New Drug Application for the use of dutasteride for prostate cancer chemoprevention. The 5-ARIs can also be used to manage hemospermia and prostatic hematuria, and to prevent intraoperative bleeding, although there is insufficient evidence for a standard strategy. This review summarizes the current use of 5-ARIs for prostate disease, including benign prostate hyperplasia, prostate cancer, prostate-related bleeding, and hemospermia.
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ABSTRACT: Finasteride is an antiandrogen that inhibits 5-α-reductase, an enzyme that converts testosterone to dihydrotestosterone. Finasteride
significantly reduces intraoperative bleeding when 10 mg/d is administered for 60 days before transurethral resection of the
prostate. Our double-blind, randomized, placebo-controlled study evaluated 200 patients with benign prostatic hyperplasia
who underwent transurethral resection of the prostate. We compared a placebo group (n = 100) with a group (n = 100) administered 5 mg of finasteride twice a day for 8 weeks. We intended to demonstrate the mechanisms and effects of
finasteride compared with those of vascular endothelial growth factor, and to evaluate CD34, an immunohistochemical marker
of blood vessel density in the prostate. Our results indicated a lower average microvascular density and vascular endothelial
growth factor index for hypertrophic prostate in the finasteride group than in the placebo group.
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