Transurethral resection of prostate and bleeding: A prospective randomized, double blind, placebo controlled trial to see efficacy of short term use of Finasteride and Dutasteride on operative blood loss and prostatic micro-vessel density.

OBJECTIVE: To determine the efficacy of short duration use of finasteride and dutasteride prior to transurethral resection of prostate (TURP) on intraoperative blood loss and microvessel density (MVD) of prostate stroma and suburethral tissues in benign prostatic hyperplasia (BPH) Methods: This study includes 450 patients who were planned for TURP. They were prospectively randomized into three groups (150 patients each). Group 1 received placebo, group 2 received finasteride 5 mg/day and group 3 patients received dutasteride 0.5 mg/day for 4 weeks prior to surgery. The total blood loss, requirement of blood, and MVDs in prostate stroma and suburethral tissues were calculated in each patient and then compared among three groups.

RESULTS: There was significant reduction in less mean blood loss, blood loss/time, and total blood loss per gram of resected tissue in finasteride and dutasteride group compared to placebo. Prostate stromal and suburethral MVDs were significantly higher compared to placebo. Blood transfusion was required in 9.3%, 2.7%, and 2% of the patients, respectively (p=0.004). However, no statistically significant differences were observed between finasteride and dutasteride groups for these parameters (p >0.05). The weight of resected prostate, operating time, and amount of irrigation fluid used did not show any significant difference between the three groups.

CONCLUSION: Short-term pretreatment with finasteride and dutasteride has similar efficacy and significantly reduces perioperative bleeding during TURP and has minimal negative impact on sexual function. According to our findings, a 4 weeks' prior administration of 5-ARIs may reduce operative blood loss and prostatic MVD in TURP, thus potentially decreasing blood loss- related complications and the requirement of blood transfusion.