Rammah Ahmed M, Meshref Alaa, Soliman Ebram, Abd Elaziz Islam Nasser, Habib Enmar, Abdelaziz Ahmed Yehia, Abozamel Ahmed H
Department of Urology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt.
El Sahel Teaching Hospital, Cairo, Egypt.
Curr Urol. 2024 Sep;18(3):194-198. doi: 10.1097/CU9.0000000000000226. Epub 2024 Sep 20.
The aim of this study was to assess the effect of a 4-week dutasteride treatment on reducing the intraoperative and postoperative bleeding, as well as the amount and duration of irrigation required to clear the urine after transurethral resection of the prostate (TURP) ≥50 g in men receiving the antiplatelet drug (APD).
This double-blind randomized clinical trial included patients with a prostate size ≥50 g who were indicated for TURP and were already receiving APD. The study was conducted in the Urology Department of Cairo University over a 12-month period. Routine preoperative laboratory investigations were performed in all patients. Moreover, baseline prostate size, serum prostate-specific antigen level, and International Prostate Symptom Score were estimated. The patients were randomly divided into 2 equal groups (groups A and B). Group A, the dutasteride group, received dutasteride (0.5 mg) once daily for 4 weeks. Group B, the placebo group, received a placebo capsule once daily for 4 weeks. Both groups underwent bipolar TURP. Fifteen patients were excluded from the study; 9 patients from group A and 6 patients from group B, either due to drug intolerability or loss follow-up.
The mean blood loss was insignificant between the 2 groups immediately after and 24 hours after surgery (Δ hemoglobin: 1.41 ± 0.63 g/dL vs. 1.48 ± 0.54 g/dL, 2.12 ± 0.70 g/dL vs. 2.31 ± 0.78 g/dL, respectively, = 0.631, = 0.333; Δ hematocrit: 2.97% ± 1.51% vs. 3.16% ± 1.36%, 4.96% ± 1.87% vs. 5.73% ± 4.39%, respectively, = 0.610, = 0.380). However, there were significant differences in duration of indwelling urethral catheter (5.10 ± 0.55 days vs. 5.80 ± 1.79 days, = 0.048), duration of bladder irrigation (13.60 ± 2.85 hours vs. 16.33 ± 6.62 hours, = 0.044), and the amount of saline used for bladder irrigation (11.03 ± 2.30 L vs. 13.87 ± 6.13 L, = 0.046) between group A and group B. respectively.
Treatment with dutasteride for 4 weeks before TURP in men receiving APD did not significantly reduce intraoperative or postoperative bleeding after TURP but could significantly reduce the duration of indwelling catheter placement, as well as the duration and amount of saline irrigation.
本研究旨在评估在接受抗血小板药物（APD）治疗的男性中，为期4周的度他雄胺治疗对减少经尿道前列腺切除术（TURP）≥50 g患者术中及术后出血，以及清除尿液所需冲洗量和冲洗持续时间的影响。
这项双盲随机临床试验纳入了前列腺大小≥50 g且适合接受TURP并已在接受APD治疗的患者。该研究在开罗大学泌尿外科进行，为期12个月。所有患者均进行了常规术前实验室检查。此外，还评估了基线前列腺大小、血清前列腺特异性抗原水平和国际前列腺症状评分。患者被随机分为2个相等的组（A组和B组）。A组为度他雄胺组，每天服用一次度他雄胺（0.5 mg），持续4周。B组为安慰剂组，每天服用一次安慰剂胶囊，持续4周。两组均接受双极TURP。15名患者被排除在研究之外；A组9名患者，B组6名患者，原因是药物不耐受或失访。
两组术后即刻及术后24小时的平均失血量无显著差异（血红蛋白变化：分别为1.41±0.63 g/dL对1.48±0.54 g/dL，2.12±0.70 g/dL对2.31±0.78 g/dL，P = 0.631，P = 0.333；血细胞比容变化：分别为2.97%±1.51%对3.16%±1.36%，4.96%±1.87%对5.73%±4.39%，P = 0.610，P = 0.380）。然而，A组和B组在留置尿道导管的持续时间（5.10±0.55天对5.80±1.79天，P = 0.048）、膀胱冲洗的持续时间（13.60±2.85小时对16.33±6.62小时，P = 0.044）以及用于膀胱冲洗的生理盐水用量（11.03±2.30 L对13.87±6.13 L，P = 0.046）方面存在显著差异。
在接受APD治疗的男性中，TURP术前4周使用度他雄胺治疗并不能显著减少TURP术后的术中或术后出血，但可显著缩短留置导管的时间以及生理盐水冲洗的时间和用量。
