Abstract
OBJECTIVES:To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery.METHODS:We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders.RESULTS:Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters.CONCLUSIONS:This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.
Highlights
The adjusted odds ratio (AOR) for blood transfusion was significantly elevated in patients aged X80 years compared to patients aged 7079 years (1.65; 95% CI, 1.21-2.25, p=0.0017)
Patients who underwent TURP at regional hospitals had a significantly higher risk of blood transfusion than patients who underwent surgery at other medical centers (AOR, 1.49, 95% CI, 1.11-1.99)
The blood transfusion rates for patients treated without 5-alpha-reductase inhibitors (5ARIs), patients treated with 5ARIs for o3 months, and patients treated with 5ARIs for X3 months were 15.7%, 10.9%, and 0%, respectively, in patients with coagulopathy
Summary
Transurethral resection of the prostate (TURP) is the current standard operative procedure for the management of bothersome lower urinary tract symptoms caused by benign. Received for publication on July 5, 2017. Accepted for publication on October 17, 2017. Perioperative hemorrhagic events are common TURP-related complications [2]. The incidence rate of bleeding requiring transfusion reportedly ranges from 0.4% to 7.1% [3]. In addition to necessitating blood transfusion, perioperative hemorrhage may result in blood clot retention, which may require surgical intervention [4]
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