A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia

Abstract

1 5a-reductase inhibitors (5a-RIs), including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia (BPH). Many studies reported that preoperative 5a-RI had impact on intraoperative haemorrhage during surgery for BPH, but it was still in controversial. So, we conducted a systematic review of the effects and mechanisms of 5a-RIs on intraoperative bleeding for BPH. MEDLINE, EMBASE, the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis. Sixteen publications involving 15 different randomized controlled trials (RCTs) and a total of 1156 patients were used in the analysis, including 10 RCTs for finasteride and five RCTs for dutasteride. We found that preoperative finasteride treatment decreases microvessel density (MVD) in resected prostate specimens. Total blood loss, blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls. Dutasteride appeared to have no effect on bleeding. This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH. Preoperative dutasteride had no effect on intraoperative haemorrhage, but further high-quality prospective studies are still needed to confirm this observation. Asian Journal of Andrology (2011) 13, 812-818; doi:10.1038/aja.2011.86; published online 5 September 2011Keywords: 5a-reductase inhibitor; benign prostate hyperplasia; haemorrhage; meta-analysis; microvessel density INTRODUCTION 5a-reductase inhibitors (5a-RIs), including finasteride and dutasteride, are commonly used medical therapies for benign prostatic hyperplasia (BPH). Finasteride, a type II 5a-RI, blocks the conversion of testosterone to dihydrotestosterone. Inhibition of 5a-reductase reduces the concentration of dihydrotestosterone in the prostate, which results in a decreased volume of the prostate, improved urinary flow and a decline in the incidence of acute urinary retention and the need for surgery.

Risk Factors for Delayed Hematuria Following Photoselective Vaporization of the Prostate

“…The effect of 5ARI use on intraoperative and postoperative bleeding has been studied for standard TURP, with some studies showing a decrease in bleeding for those on 5ARIs compared to controls and other studies showing no difference. [22][23][24][25][26] However, to our knowledge no other studies have looked directly at the effect of 5ARI use on delayed hematuria, specifically after PVP. Our results suggest a role for 5ARIs in reducing post-PVP hematuria, and the utility of prospective, randomized studies to elucidate exactly what that role may be.…”

A Systematic Review and Meta-Analysis of the Effects on Dutasteride Treatment for Reducing Surgical Blood Loss during Transurethral Resection of the Prostate

“…Previous studies showed that finasteride could reduce perioperative bleeding in patients undergoing TURP [6][7][8][9][10][11][12] . However, the effect of preoperative treatment with dutasteride in reducing blood loss during TURP remains controversial [11,12] . Our meta-analysis reviewed 10 available comparative studies involving 1,022 participants (521 treated with dutasteride and 501 in the control group); it indicated that preoperative administration of dutasteide could significantly reduce the change of Hb and Hct level in TURP patients.…”

“…Theoretically, dutasteride should also be effective in reducing blood loss. Two systematic review and meta-analyses conducted by Zong et al [11] and Zhu et al [12] identified that preoperative dutasteride use could not decrease bleeding during TURP. However, only 4 studies [14][15][16][17] about dutasteride were included in their analysis and different reference values were used to classify the intraoperative blood loss.…”

Effect of Preoperative Dutasteride on Bleeding Related to Transurethral Resection of Prostate in Patients with Benign Prostatic Hyperplasia

“…This feature was used to prevent blood loss related to TURP. The efficacy of dutasteride in the treatment of gross hematuria associated with BPH is well established [5] [6] [7].…”