Does dutasteride reduce perioperative blood loss and postoperative complications after transurethral resection of the prostate?

Shanmugasundaram, R.; Singh, J. Chandra; Kekre, Nitin S.
July 2007
Indian Journal of Urology;Jul-Sep2007, Vol. 23 Issue 3, p334
Academic Journal
The primary objective of this multicentric prospective randomized trial[1] was to determine whether pretreatment with dutasteride, a dual 5α-reductase inhibitor (5ARI), reduces surgical blood loss in patients who undergo transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) with prostates ± 30 ml volume. The secondary objectives were to assess bleeding after TURP and postoperative complications like clot retention, blood transfusions, urinary tract infection (UTI), incontinence and acute urinary retention (AUR) following TURP. Two hundred and thirteen men aged 52-85 years (mean 67) with prostate volume of ± 30 ml were recruited from 23 centers across six countries. Two hundred and two had TURP and 197 completed the study. They were randomized to three groups: Group I receiving placebo for four weeks preoperatively and two weeks postoperatively, Group II receiving placebo for two weeks followed by dutasteride 0.5 mg for two weeks preoperatively and two weeks of dutasteride 0.5 mg daily among the treatment groups. Hemoglobin loss after TURP was about a third of the total surgical blood loss. one to three per cent of the patients in each group received blood transfusions. Clot retention occurred in 6-11% of the patients, AUR in 11-17%, UTI in 20-31% and urinary incontinence in 14-15% of the patients over 14 weeks, but there was no statistically significant differences among groups. Treatment with dutasteride did not alter the MVD in the prostatic urethra or in regions of nodular hyperplasia. The drug reduced the serum concentration of DHT by 86-89% ( P<0.001), while increasing serum testosterone level by 13-15% before treatment. Dutasteride also reduced the intraprostatic concentration of DHT by 10 times compared with placebo. No adverse events that were considered to be drug-related were recorded.


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