Transurethral Resection of Prostate and Bleeding: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial to See the Efficacy of Short-Term Use of Finasteride and Dutasteride on Operative Blood Loss and Prostatic Microvessel Density.

Abstract

The aim of this study was to determine the efficacy of short-duration use of finasteride and dutasteride before transurethral resection of the prostate (TURP) on intraoperative blood loss and microvessel density (MVD) of prostate stroma and suburethral tissues in benign prostatic hyperplasia (BPH). This study includes 450 patients who were planned for TURP. They were prospectively randomized into three groups (150 patients each). Group 1 received placebo, group 2 received finasteride, 5 mg per day, and group 3 patients received dutasteride, 0.5 mg per day, for 4 weeks before surgery. The total blood loss, requirement of blood, and MVDs in prostate stroma and suburethral tissues were calculated in each patient and then compared among three groups. There was significant reduction in mean blood loss, blood loss/time, and total blood loss per gram of resected tissue in finasteride and dutasteride groups compared with placebo. Prostate stromal and suburethral MVDs were significantly higher compared with placebo. Blood transfusion was required in 9.3%, 2.7%, and 2% of the patients, respectively (p = 0.004). However, no statistically significant differences were observed between finasteride and dutasteride groups for these parameters (p > 0.05). The weight of resected prostate, operating time, and amount of irrigation fluid used did not show any significant difference between the three groups. Short-term pretreatment with finasteride and dutasteride has similar efficacy and significantly reduces perioperative bleeding during TURP and has minimal negative impact on sexual function. According to our findings, a 4-week prior administration of 5-alpha-reductase inhibitors may reduce operative blood loss and prostatic MVD in TURP, thus potentially decreasing blood loss-related complications and the requirement of blood transfusion.