Transurethral Resection of Prostate and the Role of Pharmacological Treatment with Dutasteride in Decreasing Surgical Blood Loss

Purpose: Transurethral resection of prostate (TURP) still represents the gold standard in the surgical treatment of symptomatic benign prostatic hyperplasia (BPH). The most frequent complication is represented by intra-and perioperative bleeding. Preoperative use of 5-alpha-reductase inhibitors (finasteride or dutasteride) to reduce surgical bleeding is still a topic of debate in literature. Previous studies provided favorable data on blood loss reduction by preoperative administration of finasteride or dutasteride. The aim of this study was to evaluate whether pretreatment with dutasteride for six weeks before surgery can reduce surgical blood loss. Methods: A total of 142 patients with BPH-who were to undergo TURP-were enrolled and randomized into two groups. The dutasteride group comprising of 71 patients, was treated with dutasteride (0.5mg/day) for 6 weeks before surgery and the control group, comprising of other 71 patients, did not receive dutasteride. Blood loss was evaluated in terms of a reduction in the serum hemoglobin level (Delta Hb and Delta HCT), and was estimated by measuring the Hb and hematocrit levels before and 24 hours after surgery. Results: None of the patients treated with dutasteride reported any side effects. A significantly lower mean blood loss was observed in the dutasteride group compared to the control group (Delta Hb=-1.29 +/- 0.81 v -1.83 +/- 1.25, respectively, p < 0.0027; Delta HCT=-5.67 +/- 2.58 v -6.50 +/- 2.40, respectively, p < 0.0491). Conclusions: Our results showed that pretreatment with dutasteride for 6 weeks before TURP reduces the surgical bleeding considerably. This treatment schedule can be used routinely to decrease TURP surgical bleeding.