Hahn Robert G, Fagerström Tim, Tammela Teuvo L J, Van Vierssen Trip Oncko, Beisland Hans Olav, Duggan Annette, Morrill Betsy
Department of Anaesthesia, South Hospital, 118 83 Stockholm, Sweden.
BJU Int. 2007 Mar;99(3):587-94. doi: 10.1111/j.1464-410X.2006.06619.x.
To determine whether pretreatment with dutasteride, a dual 5alpha-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).
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, Angelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips.
Although dutasteride reduced serum dihydrotestosterone (DHT) by 86-89% in 2-4 weeks, and intraprostatic DHT was approximately 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.
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.
确定双重5α-还原酶抑制剂（5ARI）度他雄胺预处理是否能减少接受经尿道前列腺切除术（TURP）的良性前列腺增生（BPH）患者的手术失血或术后并发症。
这项双盲、随机、安慰剂对照、多中心研究纳入了214例BPH患者。将安慰剂与度他雄胺0.5mg/天在TURP术前2周和术后2周，或术前4周和术后2周进行比较。使用血红蛋白光度计（HemoCue AB，瑞典安吉尔霍尔姆）测量手术失血量，并记录术后不良事件。通过对前列腺组织切片进行免疫染色和光学显微镜检查计算微血管密度（MVD）。
尽管度他雄胺在2 - 4周内使血清双氢睾酮（DHT）降低了86 - 89%，前列腺内DHT比安慰剂组低约10倍，但手术期间（校正后）平均血红蛋白（Hb）损失为2.15 - 2.55g Hb/g切除组织，TURP术中或术后两组间失血量无显著差异。TURP术后14周内，6 - 11%的患者出现血块残留，14 - 15%的患者出现尿失禁，两组间无差异。所有组TURP时的MVD也相似。
与安慰剂相比，尽管度他雄胺能显著抑制前列腺内DHT，但TURP术中或术后失血量及术后并发症并无显著减少。安慰剂组的失血量和输血率低于先前报道的5ARI相对于安慰剂对TURP术中出血有有益作用的研究中的数值。
