Bansal Ankur, Arora Aditi
Janak Surgicare Centre , Patiala, India .
J Endourol. 2017 Sep;31(9):910-917. doi: 10.1089/end.2016.0696-rev. Epub 2017 Jun 26.
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.
本研究旨在确定在经尿道前列腺切除术（TURP）前短期使用非那雄胺和度他雄胺对良性前列腺增生（BPH）患者术中失血量以及前列腺基质和尿道下组织微血管密度（MVD）的影响。
本研究纳入450例计划行TURP的患者。他们被前瞻性随机分为三组（每组150例）。第1组接受安慰剂，第2组接受非那雄胺，每日5毫克，第3组患者接受度他雄胺，每日0.5毫克，术前用药4周。计算每位患者的总失血量、输血量需求以及前列腺基质和尿道下组织的MVD，然后在三组之间进行比较。
与安慰剂组相比，非那雄胺组和度他雄胺组的平均失血量、失血/时间以及每克切除组织的总失血量均显著降低。前列腺基质和尿道下组织的MVD显著高于安慰剂组。三组患者的输血率分别为9.3%、2.7%和2%（p = 0.004）。然而，在这些参数方面，非那雄胺组和度他雄胺组之间未观察到统计学显著差异（p > 0.05）。三组之间切除前列腺的重量、手术时间和冲洗液用量均无显著差异。
非那雄胺和度他雄胺短期预处理具有相似的疗效，可显著减少TURP术中围手术期出血，对性功能的负面影响最小。根据我们的研究结果，术前4周给予5α-还原酶抑制剂可能减少TURP术中的手术失血量和前列腺MVD，从而可能降低与失血相关的并发症和输血需求。
