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

• Published in: BJU international 2007-03, Vol.99 (3), p.587-594
• Main Authors: Hahn, Robert G., Fagerström, Tim, Tammela, Teuvo L.J., Van Vierssen Trip, Oncko, Beisland, Hans Olav, Duggan, Annette, Morrill, Betsy
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Azasteroids - therapeutic use; Biological and medical sciences; blood loss; Blood Loss, Surgical - prevention & control; blood vessels; BPH; Double-Blind Method; doubleblind; double‐blind; Dutasteride; Enzyme Inhibitors - therapeutic use; Humans; Male; mannitol; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Nephrology. Urinary tract diseases; Postoperative Care - methods; Postoperative Complications - prevention & control; Preoperative Care - methods; Prostatic Hyperplasia - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; surgical; Transurethral Resection of Prostate - adverse effects; Treatment Outcome; Tumors of the urinary system; TURP; Urinary tract. Prostate gland
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06619.x

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.