Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study

Ozdal, Ozdem Levent; Özden, Cüneyt; Benlı, Kemal; Gokkaya, Serkan; Bulut, Süleyman; Memiş, Ali

doi:10.1038/sj.pcan.4500818

Cited by 49 publications

(48 citation statements)

References 28 publications

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“…Recent evidence has demonstrated a 4-week course of Finasteride, pre-operatively, results in a reduction in the total amount of bleeding and the amount of bleeding per gram of resected tissue at TURP. 12 Similar conclusions have been drawn from shorter courses of only 2-week Finasteride 13 but have yet to be clearly demonstrated with Dutasteride.…”

supporting

confidence: 62%

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Lynch

Sriprasad

Thompson³

2010

Ann R Coll Surg Engl

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Ann R Coll Surg Engl 2010; 92: 555-558 555There are several techniques of transurethral prostatic surgery including the traditional transurethral resection of the prostate (TURP) and newer techniques including holmium laser enucleation of the prostate (HoLEP), Green-light laser photoselective vaporisation of the prostate (PVP) and the Gyrus bipolar system. The number of TURPs is falling 1 and there is no doubt that newer techniques are being accepted as established alternatives. Bleeding is one of the main complications after any modality of endoscopic prostatectomy, including TURP. The incidence of blood loss requiring transfusion is reported to be 0.4-7.1%, 2,3 with rates declining with evolving technology despite an increasingly aged population having prostatic surgery.The experience of surgeons dealing with troublesome bleeding is now, therefore, much less. The conservative, resuscitative and endoscopic measures to deal with bleeding are well established and understood. However, there are occasions when this is not sufficient to stop what may be life-threatening haemorrhage and many surgeons may now be unfamiliar with the surgical technique of packing the prostatic cavity to arrest bleeding when other measures have failed. In this paper, we have reviewed all TURP and PVP procedures over a 3-year period and identified those patients who required surgical intervention postoperatively to arrest continuing haemorrhage and in particular describe open packing of the prostate. Patients and MethodsWe retrospectively reviewed a 3-year period where 437 TURPs and 590 PVPs were performed for lower urinary tract symptoms (LUTS) and for urinary retention in our institution. Of patients who underwent TURP, 19 needed a cystoscopy in the immediate postoperative period for persistent bleeding despite conservative measures such as catheter traction and manual bladder washouts. Two patients who , is uncommon but a significant and life-threatening problem. The knowledge and technical experience to deal with this complication may not be wide-spread among urologists and trainees. We describe our series of TURPs and PVPs and the incidence of postoperative bleeding requiring intervention. PATIENTS AND METHODS We retrospectively reviewed 437 TURPs and 590 PVPs over 3 years in our institution. We describe the conservative, endoscopic and open prostatic packing techniques used for patients who experienced postoperative bleeding. RESULTS Of 437 TURPs, 19 required endoscopic intervention for postoperative bleeding. Of 590 PVPs, two patients were successfully managed endoscopically for delayed haemorrhage at 7 and 13 days post-surgery, respectively. In one TURP and one PVP patient, endoscopic management was insufficient to control postoperative haemorrhage and open exploration and packing of the prostatic cavity was performed. CONCLUSIONS Significant bleeding after endoscopic prostatic surgery is still a potentially life-threatening complication. Prophylactic measures have been employed to reduce peri-operative bleeding but persistent ble...

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supporting

confidence: 62%

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Lynch

Sriprasad

Thompson³

2010

Ann R Coll Surg Engl

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“…Hematuria resolves within1-2 weeks after the treatment with finasteride in 80% of the patients [1,4,5]. Bladder out flow obstruction symptoms decrease subsequently after decreasing DHT levels leading to decease glandular and fibro muscular tissue of the prostate and overall decrease of the prostate tissue by 25-30% after 6-12 months treatment by finasteride [1,4] .…”

Section: Introductionmentioning

confidence: 99%

“…Ozdal, et al [5] demonstrated the effect of short term pretreatment with finasteride in BPH patients. They collected 40 patients with BPH who will perform TURP and randomized them into 2 groups, 20 of them received 5 mg of finasteride for 4 weeks while other 20 patients act as a control.…”

Section: Introductionmentioning

confidence: 99%

“…When medical treatment fails, surgery will be 1 st line of treatment [1,5,6]. Hematuria following TURP represents the most bothering complication [1,[5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Finasteride as a Neo-Adjuvant Treatment for TURPLiterature Review

Kotb¹

2016

JURNOA

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Mini Reviewthe rate of postoperative complications [1,[3][4][5][6][7].Finasteride is usually given from 2weeks to 6 months preoperatively to decrease angiogenesis and Microvascular Density (MVD) which leads to decrease the bleeding during and after TURP [6][7]. Pre-operative treatment with finasteride for 6 months also leads to overall decrease in the size of prostate tissue which indirectly will decrease the operative time [6]. Shanmugasundaram, et al. [8] conducted multi center Randomized Control Trial (RCT) about the role of 5ARIs in the pre and post-operative settings and they found that 5ARIs decrease the operative bleeding and post-operative complications such as blood transfusion , clot retention, urinary tract infections and post TURP urinary retention. MethodsPubMed search of all English literatures correlating bleeding associated with TURP and finasteride treatment by two independent researchers, over 3 months. This was followed with a group discussion to choose relevant publications to be included in the manuscript. ResultsFew publications were identified concerning our study objective. We could retrieve data concerning Data mechanism of action of finasteride and the suggested duration of treatment. DiscussionFinasteride has been widely used as the 1 st line of treatment of BPH and hematuria associated with it [1]. Most of urologists use the 5ARI as treatment for the hematuria associated with BPH more than a pre-TURP treatment to decrease the bleeding [1,9] . Hagerty, et al. [10] conducted the 1 st prospective cohort study about the role of preoperative finasteride for 25 patients given finasteride for about 2-4 months and 50 controls without treatment. They followed both groups for 4 months and found that only 8.3% of patients underwent preoperative treatment experienced perioperative bleeding while 37% of the control group got bleeding during the operation. So, they concluded that preoperative finasteride decreases the bleeding rate, postoperative complication such as clot retention especially in AbstractObjective: Conducting a mini review of the role of Finasteride in decreasing blood loss associated with TURP. Methods:PubMed search of all English literatures correlating bleeding associated with TURP and finasteride treatment by two independent researchers, over 3 months. This was followed with a group discussion to choose relevant publications to be included in the manuscript.Results: Few publications were identified concerning our study objective. Data were retrieved concerning mechanism of action of finasteride and suggested duration of treatment. Conclusion:Finasteride is an effective drug that may be considered pre-TURP for patients with prostatic volume more than 30 cc. The duration of treatment ranges from 1-6 weeks depending on the prostatic volume.

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Pre-surgical finasteride to reduce perioperative bleeding and other complications following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH)

Zhang¹,

Dong²,

Shang³

et al. 2010

Cochrane Database of Systematic Reviews

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Effect of short-term finasteride therapy on peroperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study

Cited by 49 publications

References 28 publications

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP)

Finasteride as a Neo-Adjuvant Treatment for TURPLiterature Review

Pre-surgical finasteride to reduce perioperative bleeding and other complications following transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH)

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