The relationship between 5α-reductase inhibitors and blood loss from the prostate has been well described and investigated previously. In a well-conducted study, authors from Sweden show that dutasteride, despite significantly lowering the tissue dihydrotestosterone levels, did not lower blood loss or transfusion rates after TURP.

OBJECTIVE

To determine whether pretreatment with dutasteride, a dual 5α-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).

PATIENTS AND METHODS

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, Ängelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips.

RESULTS

Although dutasteride reduced serum dihydrotestosterone (DHT) by 86–89% in 2–4 weeks, and intraprostatic DHT was ≈ 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.

CONCLUSION

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.

REFERENCES

1 Uchida T, Ohori M, Soh S et al. Factors influencing morbidity in patients undergoing transurethral resection of the prostate. Urology 1999; 53: 98–105
2 Ekengren J, Hahn RG. Blood loss during transurethral resection of the prostate as measured with the HemoCue photometer. Scand J Urol Nephrol 1993; 27: 501–7
3 Carlin BI, Bodner DR, Spirnak JP, Resnick MI. Role of finasteride in the treatment of recurrent hematuria secondary to benign prostatic hyperplasia. Prostate 1997; 31: 180–2
4 Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology 1998; 51: 237–40
5 Sieber PR, Rommel FM, Huffnagle HW et al. The treatment of gross hematuria secondary to prostatic bleeding with finasteride. J Urol 1998; 159: 1232–3
6 Foley SJ, Soloman LZ, Wedderburn AW et al. A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride. J Urol 2000; 163: 496–8
7 Delakas D, Lianos E, Karyotis I, Cranidis A. Finasteride: a long-term follow-up in the treatment of recurrent hematuria associated with benign prostatic hyperplasia. Urol Int 2001; 67: 69–72
8 Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int 2000; 85: 70–3
9 Hagerty JA, Ginsberg PC, Harmon JD, Harkaway RC. Pretreatment with finasteride decreases perioperative bleeding associated with transurethral resection of the prostate. Urology 2000; 55: 684–9
10 Ukimura O, Kawauchi A, Kanazawa M et al. Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study. BJU Int 2005; 96: 98–102
11 Donohue JF, Sharma H, Abraham R, Natalwala S, Thomas DR, Foster MC. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of the role of finasteride for decreasing operative blood loss. J Urol 2002; 168: 2024–6
12 Crea G, Sanfilippo G, Anastasi G, Magno C, Vizzini C, Inferrera A. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urol Int 2005; 74: 51–3
13 Özdal ÖL, Özden C, Benli K, Gokkaya S, Bulut S, Memis A. Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study. Prostate Cancer Prostatic Dis 2005; 8: 215–8
14 Sandfeldt L, Bailey DM, Hahn RG. Blood loss during transurethral resection of the prostate after 3 months of treatment with finasteride. Urology 2001; 58: 972–6
15 Lund L, Möller Ernst-Jensen K, Torring N, Erik Nielsen J. Impact of finasteride treatment on perioperative bleeding before transurethral resection of the prostate: a prospective randomized study. Scand J Urol Nephrol 2005; 39: 160–2
16 Boccon-Gibod L, Valton M, Ibrahim H, Boccon-Gibod L, Comenducci A. [Effect of dutasteride on reduction of intraoperative bleeding related to transurethral resection of the prostate]. Prog Urol 2005; 15: 1085–9
17 Bramson HN, Hermann D, Batchelor KW, Lee FW, James MK, Frye SV. Unique preclinical characteristics of GG745, a potent dual inhibitor of 5AR. J Pharmacol Exp Ther 1997; 282: 1496–502
18 Roehrborn CG, Andriole G, Schalken JA, Wilson T, Clark RV. Dutasteride, a novel dual 5-alpha reductase inhibitor, reduces serum DHT to a greater extent versus finasteride and achieves finasteride maximal reduction in a larger proportion of patients. Eur Urol Suppl 2003; 2: 161, Abstract 635
19 Wurzel R, Ray P, Major-Walker K, Shannon J. Inhibition of type I and type II 5-alpha reductase with dutasteride (0.5 mg) significantly reduces intraprostatic dihydrotestosterone in BPH patients. AUA Meeting 2006 (Abstract)
20 Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a preliminary report. J Urol 1995; 154: 1779–82
21 Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3885 patients. J Urol 1989; 141: 243–7
22 Hahn RG. Influence of variations in blood haemoglobin concentration on the calculation of blood loss and volumetric irrigating fluid balance during transurethral resection of the prostate. Br J Anaesth 1987; 59: 1223–9
23 Jansen H, Berseus O, Johansson JE. A simple photometric method for determination of blood loss during transurethral surgery. Scand J Urol Nephrol 1978; 12: 1–5
24 Marshall S, Narayan P. Treatment of prostatic bleeding: suppression of angiogenesis by androgen deprivation. J Urol 1993; 149: 1553–4
25 Lekas E, Bergh A, Damber JE. Effects of finasteride and bicalutamide on prostatic blood flow in the rat. BJU Int 2000; 85: 962–5
26 Andriole G, Humphrey P, Ray P et al. Effect of the dual 5α-reductase inhibitor dutasteride on markers of tumor regression in prostate cancer. J Urol 2004; 172: 915–9
27 Haggstrom S, Torring N, Moller K et al. Effects of finasteride on vascular endothelial growth factor. Scand J Urol Nephrol 2002; 36: 182–7
28 Canda AE, Mungan MU, Yilmaz O, Yorukoglu K, Tuzel E, Kirkali Z. Effects of finasteride on vascular surface density, number of microvessels and vascular endothelial growth factor expression of the rat prostate. Int Urol Nephrol 2006; 38: 275–80
29 Pareek G, Shevchuk M, Armenakas NA et al. The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density: a possible mechanism for decreased prostatic bleeding in treated patients. J Urol 2003; 169: 20–3
30 Donohue JF, Hayne D, Karnik U, Thomas DR, Foster MC. Randomized, placebo-controlled trial showing that finasteride reduces prostatic vascularity rapidly within 2 weeks. BJU Int 2005; 96: 1319–22

Citing Literature

Volume99, Issue3

March 2007

Pages 587-594

Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride

Abstract

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSION

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride

Abstract

OBJECTIVE

PATIENTS AND METHODS

RESULTS

CONCLUSION

REFERENCES

Citing Literature

References

Related

Information