Preoperative Dutasteride Use has no effect on Intraoperative Bleeding during Transvesical Open Simple Prostatectomy for Benign Prostatic Hyperplasia

Abstract

Objective There are a few studies in the literature investigating the effect of preoperative dutasteride use on bleeding in open simple prostatectomy. We aimed to evaluate the effect of preoperative dutasteride use on perioperative bleeding during open simple prostatectomy.

Methods We retrospectively analyzed the medical records of all patients who underwent transvesical open prostatectomy due to benign prostatic hyperplasia in our institution between 2008 and 2018. Patients were divided into 2 groups regarding the use of dutasteride prior to surgery as group 1 = received dutasteride during at least six weeks prior to surgery; group 2 = dutasteride naive.

Results: A total of 167 patients who met the inclusion criteria were included in the study. The mean operative time was 86.5±18.7 min while the estimated blood loss was 640.7±55.7 ml. There was no statistically significant difference in operative time, estimated blood loss, hemoglobin, and hematocrit decrease among the two groups.

Conclusion We were not able to find an advantage of pre-operative dutasteride use in terms of perioperative bleeding in open simple prostatectomy performed for benign prostatic hyperplasia.

Zusammenfassung

Zielsetzung Es gibt einige Studien in der Literatur, in denen die Wirkung einer präoperativen Anwendung von Dutasterid auf Blutungen bei offener einfacher Prostatektomie untersucht wird. Unser Ziel war die Beurteilung der Wirkung von präoperativ verabreichtem Dutasterid auf perioperative Blutungen bei offener einfacher Prostatektomie.

Methoden Wir führten eine retrospektive Analyse der Krankenakten aller Patienten durch, die sich aufgrund von benigner Prostatahyperplasie zwischen 2008 und 2018 an unserem Institut einer transvesikalen offenen Prostatektomie unterzogen. Die Patienten wurden hinsichtlich der präoperativen Anwendung von Dutasterid wie folgt in 2 Gruppen unterteilt: Gruppe 1 erhielt über einen Mindestzeitraum von 6 Wochen vor der Operation Dutasterid, Gruppe 2 wurde nicht mit Dutasterid vorbehandelt.

Ergebnisse Insgesamt wurden 167 Patienten, die die Einschlusskriterien erfüllten, in die Studie aufgenommen. Die mittlere Operationszeit lag bei 86,5±18,7 min, der Blutverlust wurde auf 640,7±55,7 ml geschätzt. Zwischen den beiden Gruppen wurden keine statistisch signifikanten Unterschiede in Bezug auf Operationszeit, geschätzten Blutverlust und Abnahme der Hämoglobin- und Hämatokritwerte festgestellt.

Schlussfolgerung Wir konnten hinsichtlich perioperativer Blutungen bei offener einfacher Prostatektomie zur Behandlung der benignen Prostatahyperplasie keinen Nutzen einer präoperativen Anwendung von Dutasterid feststellen.

Keywords

benign prostatic hyperplasia - bleeding - dutasteride - open simple prostatectomy - 5α-reductase inhibitors

Schlüsselwörter

5α-Reduktase-Inhibitoren - benigne Prostatahyperplasie - Dutasterid - Blutung - offene einfache Prostatektomie

• References

• 1 Pariser JJ, Packiam VT, Adamsky MA. et al. Trends in Simple Prostatectomy for Benign Prostatic Hyperplasia. Curr Urol Rep 2016; 17: 57
• 2 Oelke M, Bachmann A, Descazeaud A. et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 2013; 64: 118-140
• 3 Kim JH, Baek MJ, Sun HY. et al. Efficacy and safety of 5 alpha-reductase inhibitor monotherapy in patients with benign prostatic hyperplasia: A meta-analysis. PLoS One 2018; 13: e0203479
• 4 Rieken M, Gratzke C. Have we really abandoned open simple prostatectomy today?. Eur Urol 2014; 66: 292-293
• 5 Giulianelli R, Gentile BC, Mirabile G. et al. Bipolar plasma enucleation of the prostate vs. open prostatectomy in large benign prostatic hyperplasia: a single centre 3-year comparison. Prostate Cancer Prostatic Dis 2019; 22: 110-116
• 6 Bansal A, Arora A. Transurethral Resection of Prostate and Bleeding: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial to See the Efficacy of Short-Term Use of Finasteride and Dutasteride on Operative Blood Loss and Prostatic Microvessel Density. J Endourol 2017; 31: 910-917
• 7 Pastore AL, Mariani S, Barrese F. et al. Transurethral resection of prostate and the role of pharmacological treatment with dutasteride in decreasing surgical blood loss. J Endourol 2013; 27: 68-70
• 8 Ren J, Lai S, Jiang Z. et al. A Systematic Review and Meta-Analysis of the Effects on Dutasteride Treatment for Reducing Surgical Blood Loss during Transurethral Resection of the Prostate. Urol Int 2017; 98: 456-465
• 9 Demirbas A, Resorlu B, Gulpinar MT. et al. Does Preoperative Use of Dutasteride Decrease Bleeding During Open Prostatectomy?. Urol J 2018; 15: 48-52
• 10 Gökçe Mİ, Kerimov S, Akıncı A. et al. Effect of dutasteride treatment on reducing blood loss and in perioperative period of open prostatectomy. Turk J Urol 2015; 41: 24-26
• 11 Naspro R, Suardi N, Salonia A. et al. Holmium laser enucleation of the prostate versus open prostatectomy for prostates >70 g: 24-month follow-up. Eur Urol 2006; 50: 563-568
• 12 Gross AJ, Netsch C, Knipper S. et al. Complications and early postoperative outcome in 1080 patients after thulium vapoenucleation of the prostate: results at a single institution. Eur Urol 2013; 63: 859-867
• 13 McCullough TC, Heldwein FL, Soon SJ. et al. Laparoscopic versus open simple prostatectomy: an evaluation of morbidity. J Endourol 2009; 23: 129-133
• 14 Porpiglia F, Terrone C, Renard J. et al. Transcapsular adenomectomy(Millin): a comparative study, extraperitoneal laparoscopy versus open surgery. Eur Urol 2006; 49: 120-126
• 15 Chughtai BI, Simma-Chiang V, Lee R. et al. Trends and Utilization of Laser Prostatectomy in Ambulatory Surgical Procedures for the Treatment of Benign Prostatic Hyperplasia in New York State (2000-2011). J Endourol 2015; 29: 700-706
• 16 Pariser JJ, Pearce SM, Patel SG. et al. National Trends of Simple Prostatectomy for Benign Prostatic Hyperplasia With an Analysis of Risk Factors for Adverse Perioperative Outcomes. Urology 2015; 86: 721-725
• 17 Varkarakis I, Kyriakakis Z, Delis A. et al. Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology 2004; 64: 306-310
• 18 Gratzke C, Schlenker B, Seitz M. et al. Complications and early postoperative outcome after open prostatectomy in patients with benign prostatic enlargement: results of a prospective multicenter study. J Urol 2007; 177: 1419-1422
• 19 Mohyelden K, Abdel-Kader O. Open prostatectomy with a rectal balloon: A new technique to control postoperative blood loss. Arab J Urol 2015; 13: 100-106
• 20 Roehrborn CG, Boyle P, Nickel JC. et al. Efficacy and safety of a dual inhibitor of 5-alpha-reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia. Urology 2002; 60: 434-441
• 21 Kearney MC, Bingham J, Bergland R. et al. Clinical predictors in the use of finasteride for control of gross hematuria due to benign prostatic hyperplasia. J Urol 2002; 167: 2489-2491
• 22 Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology 1998; 51: 237-240
• 23 Pareek G, Shevchuk M, Armenakas NA. et al. The effect of finasteride on the expression of vascular endothelial growth factor and microvessel density: A possible mechanism for decreased prostatic bleeding in treated patients. J Urol 2003; 169: 20-23
• 24 Memis A, Ozden C, Ozdal OL. et al. Effect of finasteride treatment on suburethral prostatic microvessel density in patients with hematuria related to benign prostate hyperplasia. Urol Int 2008; 80: 177-180
• 25 Kravchick S, Cytron S, Mamonov A. et al. Effect of short-term dutasteride therapy on prostate vascularity in patients with benign prostatic hyperplasia: a pilot study. Urology 2009; 73: 1274-1278