Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy?

Arif Demirbas, Berkan Resorlu, Murat Tolga Gulpinar, Sina Kardas, Omer Gokhan Doluoglu, Abdulkadir Tepeler, Muhammet Fatih Kilinc, Tolga Karakan, Serkan Ozcan

Abstract


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Purpose: To investigate whether use of dutasteride, a 5-alpha reductase inhibitor, for at least four weeks preoperatively affected the blood loss during open prostatectomy (OP).
Materials and methods: Retrospective analysis was made of the data of 110 patients who had undergone OP. Group I comprised 50 patients that used dutasteride for 4 weeks preoperatively, and Group II comprised 60 patients that did not use the drug. The groups were compared in respect of age, total prostate specific antigen (TPSA) levels, prostate volumes, preoperative hemoglobin (Hgb) and hematocrit (Hct) levels, postoperative reduction of Hgb and Hct, percentage reduction in Hgb and Hct, and the administration of postoperative blood products.
Results: No differences were determined between the two groups in respect of prostate volumes, TPSA, preoperative Hgb and Hct levels (P = .813, P = .978, P = .422, P =.183, respectively). Postoperative Hgb reduction was 2.19 ± 1.36 g/dL in Group I, and 2.5 ± 1.47 g/dL in Group II (P = .260). Hgb reduction was calculated as 16.4 ± 9.7% in Group I and 17.6 ± 9.7% in Group II (P = .505). Reductions in Hct were 5.8 ± 3.7% in Group I, and 7.3 ± 4.4% in Group II, and percent reductions were 14.8 ± 9.4% in Group I and 17.3 ± 10.2% in Group II (P = .068, P = .182, respectively).
Conclusion: The use of dutasteride before OP did not affect blood loss during surgery, therefore surgery should not be delayed for the administration of dutasteride to patients.

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References


Berman DM, Rodriguez R, Veltri RW. Development, Molecular Biology and Physiology of the prostate. In: Wein AJ, editor. Campbell-Walsh Urology. 10’th edition; 2012, p. 2533-2569.

Chung BI, Sommer G, Brooks JD. Anatomy of the lower urinary tract and male genitalia. In: Wein AJ, editor. Campbell-Walsh Urology. 10’th edition; 2012, p. 33-72.

Flocks RH: The arterial distribution within the prostate gland: its role in transurethral prostatic resection. J Urol 1937.

Roehrborn CG. Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History. In: Wein AJ, editor. Campbell-Walsh Urology. 10’th edition; 2012, p. 2570-2613.

Gravas S, Bach T, Bachmann A, Drake M, Gacci M, Gratzke C, et al: Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). EAU Guidelines 2015:5-70

Modder JK, McVary KT: Suprapubic prostatectomy. Hinman’s Atlas of Urologic Surgery. 3’th edition: 472-481.

Simforoosh N, Abdi H, Kashi AH, Zare S, Tabibi A, Danesh A, Basiri A, Ziaee SA.Open prostatectomy versus transurethral resection of the prostate, where are we standing in the new era? A randomized controlled trial. Urol J. 2010 Fall;7:262-9.

Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol 1984;132:474-479.

Oesterling JE. The Origin and Development of Benign Prostatic Hyperplasia An Age- Dependent Process. Journal of Andrology 1991;12:348-55.

Carter HB, Coffey DS: The prostate: An increasing medical problem. The prostate 1990;16:39-48.

Roberts RO, Jacobsen SJ, Jacobson DJ: Longitudinal changes in peak urinary flow rates in a community based cohort. J Urol 2000; 163: 107-13.

Kirby RS: The natural history of benign prostatic hyperplasia: what have we learned in the last decade? Urology 2000; 56: 3-6.

Han M, Partin AW: Retropubic and Suprapubic Open Prostatectomy. Campbell-Walsh Urology. 10’th edition: 2695-2702.

Tubaro A, Carter S, Hind A, Vicentini C, Miano L. A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. J Urol 2001; 166: 172-6.

Varkarakis I, Kyriakakis Z, Delis A, Protogerou V, Deliveliotis C. Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology 2004; 64: 306–10.

Moody JA, Lingeman JE. Holmium laser enuclation for prostate adenoma greater than 100 gm: Comparison to open prostatectomy. J Urol 2001; 165: 459-62.

Zhu YP, Dai B, Zhang HL, Shi GH, Ye DW. Impact of preoperative 5α-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. BMC Urol.2015; 15: 47.

Foley SJ, Bailey DM. Microvessel density in prostatic hyperplazia. BJU Int 2000; 85: 70-3.

Zaitsu M, Tonooka A, Mikami K, Hattori M, Takeshima Y, Uekusa T, et al. A Dual 5α-Reductase Inhibitor Dutasteride Caused Reductions in Vascular Density and Area in Benign Prostatic Hyperplasia. ISRN Urol 2013: 863489.

Hahn RG, Fagerström T, Tammela TLJ, Trip OVV, Beisland HO, Duggan A, et al: Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride. BJU International 2007; 99: 587–94.

Ku JH, Shin JK, Cho MC, Myung JK, Moon KC Paick JS. Effect of dutasteride on the expression of hypoxia-inducible factor- 1α, vascular endothelial growth factor and microvessel density in rat and human prostate tissue. Scand J Urol Nephrol 2009; 43: 445–53.

Pastore AL, Mariani S, Barrese F, Palleschi G, Valentini AM, Pacini L, et al. Transurethral resection of prostate and the role of pharmacological treatment with dutasteride in decreasing surgical blood loss. J Endourol 2013; 27: 68-70.

Kim KS, Jeong WS, Park SY, Kim YT, Moon HS. The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate. World J Mens Health 2015; 33: 14–9.

Tuncel A, Ener K, Han O, Nalcacioglu V, Aydin O, Seckin S, et al: Effects of shortterm dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate. Scand J Urol Nephrol 2009; 43: 377–82.

Gokce MI, Kerimov S, Akinci A, Hamidi N, Faraj A, Yaman O. Effect of dutasteride treatment on reducing blood loss and in perioperative period of open prostatectomy. Turkish Journal of Urology. 2015; 41: 24–6.




DOI: http://dx.doi.org/10.22037/uj.v0i0.3693


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