The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials

doi:10.1016/j.ajur.2021.05.011

Asian Journal of Urology, 2022, 9 (1): 18-26 doi: 10.1016/j.ajur.2021.05.011

Reviews

The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials

Yudhistira Pradnyan Kloping(

),Niwanda Yogiswara,Yusuf Azmi

Universitas Airlangga Fakultas Kedokteran Ringgold Standard Institution, Jawa Timur, Indonesia

Abstract
Related Citation (15)

Download:

HTML

PDF (1847KB)
Export: BibTeX | EndNote (RIS)

Abstract

Objective: Bleeding is one of the most common complications of transurethral resection of the prostate (TURP). Several previous studies reported that administering dutasteride before surgery could reduce perioperative bleeding. We aimed to evaluate the efficacy of preoperative dutasteride treatment in benign prostatic hyperplasia patients undergoing TURP by performing a meta-analysis of relevant randomized controlled trials (RCTs).
Methods: A comprehensive literature search was performed through the electronic databases including Medline, Cochrane Library, Google Scholar, and ClinicalTrial.gov in October 2020. RCTs evaluating the role of dutasteride for TURP were screened using the eligibility criteria and the quality of RCTs was assessed using the Cochrane Risk of Bias Tool. The heterogeneity was assessed using I² statistic. The measured outcomes were hemoglobin (Hb) levels, perioperative blood loss, blood transfusion, microvessel density (MVD), and operation time. Data were pooled as mean difference (MD) and odds ratio (OR).
Results: A total of 11 RCTs consisting of 627 samples from the treatment group and 615 samples from the placebo group were analyzed. Patients that received dutasteride had less reduction in Hb levels (MD -1.10, 95% confidence interval [CI] -1.39 to -0.81, p<0.00001). Dutasteride also significantly reduced the operation time (MD -1.79, 95% CI -2.97 to -0.61, p=0.003) and transfusion rate after surgery (OR 0.34, 95% CI 0.15 to 0.77, p=0.009) compared to the control group. However, the MVD (MD -3.60, 95% CI -8.04 to 0.84, p=0.11) and perioperative blood loss in dutasteride administration for less than 4 weeks (MD 46.90, 95% CI -144.60 to 238.41, p=0.63) and more than 4 weeks (MD -190.13, 95% CI -378.05 to -2.21, p=0.05) differences were insignificant.
Conclusion: Preoperative administration of dutasteride is able to reduce bleeding during TURP, as indicated by less reduction in Hb level, lower transfusion rate, and less operation time.

Key words： Dutasteride Benign prostatic hyperplasia Bleeding Transurethral resection of the prostate

Received: 14 May 2020 Available online: 20 January 2022

Corresponding Authors: Yudhistira Pradnyan Kloping E-mail: distrayyss@gmail.com

	Service
	E-mail this article
	Add to citation manager
	E-mail Alert
	Articles by authors
	Yudhistira Pradnyan Kloping
	Niwanda Yogiswara
	Yusuf Azmi

TRENDMD:

Cite this article:

Yudhistira Pradnyan Kloping,Niwanda Yogiswara,Yusuf Azmi. The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials[J]. Asian Journal of Urology, 2022, 9(1): 18-26.

URL:

http://www.ajurology.com/EN/10.1016/j.ajur.2021.05.011 OR http://www.ajurology.com/EN/Y2022/V9/I1/18

Characteristics of included studies for meta-analysis.

PRISMA flowchart of the screening process and included studies. CENTRAL, the Cochrane Central Register of Controlled Trials. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Cochrane risk of bias assessment of the included randomized controlled trials.

Forest plot of preoperative dutasteride effect on blood loss during transurethral resection of the prostate. SD, standard deviation; IV, inverse variance; CI, confidence interval.

Forest plot of preoperative dutasteride effect on hemoglobin change. SD, standard deviation; IV, inverse variance; CI, confidence interval.

Forest plot of preoperative dutasteride effect on microvessel density. SD, standard deviation; IV, inverse variance; CI, confidence interval.

Forest plot of preoperative dutasteride effect on transfusion rate. M-H, Mantel-Haenszel; CI, confidence interval.

Forest plot of preoperative dutasteride effect on operation time. SD, standard deviation; IV, inverse variance; CI, confidence interval.

[1]	Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol 2017; 4:148e51.
[2]	Patel ND, Parsons JK. Epidemiology and etiology of benign prostatic hyperplasia and bladder outlet obstruction. Indian J Urol 2014; 30:170e6.
[3]	Tanguay S, Awde M, Brock G, Casey R, Kozak J, Lee J, et al. Diagnosis and management of benign prostatic hyperplasia in primary care. J Can Urol Assoc 2009; 3:S92. https://doi.org/10.5489/cuaj.1116.
[4]	Nickel JC, Me′ndez-Probst CE, Whelan TF, Paterson RF, Razvi H. Update: Guidelines for the management of benign prostatic hyperplasia. J Can Urol Assoc 2010; 4:310e6.
[5]	Mebust WK, Holtgrewe HL, Cockett ATK, Peters PC. Transurethral prostatectomy: Immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3885 patients. J Urol 1989; 141:243e7.
[6]	Thompson P, Lynch M, Sriprasad S, Subramonian K. TURP-PVPpacking of the prostate-haemorrhage postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP). Ann R Coll Surg Engl 2010; 92:555e8.
[7]	Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)dincidence, management, and prevention. Eur Urol 2006; 50:969e80.
[8]	Welliver CMK. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, Kavoussi LR, Partin AWPC, editors. Campbell-Walsh Urol. 11th ed. Philadelpia: Elsevier; 2016. p2504e35.
[9]	Gupta NP, Nayyar R. Management of large prostatic adenoma: Lasers versus bipolar transurethral resection of prostate. Indian J Urol 2013; 29:225e35.
[10]	Hagerty JA, Ginsberg PC, Harmon JD, Harkaway RC. Pretreatment with finasteride decreases perioperative bleeding associated with transurethral resection of the prostate. Urology 2000; 55:684e7.
[11]	Crea G, Sanfilippo G, Anastasi G, Magno C, Vizzini C, Inferrera A. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urol Int 2005; 74:51e3.
[12]	Foley SJ, Soloman LZ, Wedderburn AW, Kashif KM, Summerton D, Basketter V, et al. Re: A prospective study of the natural history of hematuria associated with benign prostatic hyperplasia and the effect of finasteride. J Urol 2000; 164:1670e1.
[13]	Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5a-reductase inhibitor. J Clin Endocrinol Metab 2004; 89:2179e84.
[14]	Keam SJ, Scott LJ. Dutasteride: A review of its use in the management of prostate disorders. Drugs 2008; 68:463e85.
[15]	Bramson HN, Hermann D, Batchelor KW, Lee FW, James MK, Frye SV. Unique preclinical characteristics of GG745, a potent dual inhibitor of 5AR. J Pharmacol Exp Therapeut 1997; 282:1496e502.
[16]	Donohue JF, Barber NJ. How do we investigate haematuria and what role has finasteride? BJU Int 2004; 93:3e4.
[17]	Ali AI, Fawzy AM, Ramadan E, El-Hawy MM, Fathelbab TK, Hussein A, et al. Six weeks finasteride monotherapy before TURP: Does it improve quality of life in early post operative period? Afr J Urol 2018; 24:221e5.
[18]	Zhu YP, Dai B, Zhang HL, Shi GH, Ye DW. Impact of preoperative 5a-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: A meta-analysis of randomized controlled trials. BMC Urol 2015; 15:47. https://doi.org/10.1186/s12894-015-0043-4. doi: 10.1186/s12894-015-0043-4
[19]	Hahn RG, Fagerström T, Tammela TLJ, Van Vierssen Trip O, Beisland HO, Duggan A, et al. Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride. BJU Int 2007; 99:587e94.
[20]	Tuncel A, Ener K, Han O, Nalcacioglu V, Aydin O, Seckin S, et al. Effects of short-term dutasteride and Serenoa repens on perioperative bleeding and microvessel density in patients undergoing transurethral resection of the prostate. Scand J Urol Nephrol 2009; 43:377e82.
[21]	Higgins JPT, Altman DG, Gøtzsche PC, Ju¨ni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011; 343: d5928. https://doi.org/10.1136/bmj.d5928. doi: 10.1136/bmj.d5928
[22]	Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005; 5:13. https://doi.org/10.1186/1471-2288-5-13. doi: 10.1186/1471-2288-5-13
[23]	Khoso MA, Matee S, Ayaz SB. Dutasteride in benign prostatic hyperplasia. Pak Armed Forces Med J 2019; 69:1047e50.
[24]	Boccon-Gibod L, Valton M, Ibrahim H, Boccon-Gibod L, Comenducci A. [Effet du dutastéride sur la réduction des saignements per-opératoires lie′s à la résection transuréthrale de prostate.] Prog Urol 2005;15:1085e9. [Article in French].
[25]	Kravchick S, Cytron S, Mamonov A, Peled R, Linov L. Effect of short-term dutasteride therapy on prostate vascularity in patients with benign prostatic hyperplasia: A pilot study. Urology 2009; 73:1274e8.
[26]	Pastore AL, Mariani S, Barrese F, Palleschi G, Valentini AM, Pacini L, et al. Transurethral resection of prostate and the role of pharmacological treatment with dutasteride in decreasing surgical blood loss. J Endourol 2013; 27:68e70.
[27]	Busetto GM, Giovannone R, Antonini G, Rossi A, Del Giudice F, Tricarico S, et al. Short-term pretreatment with a dual 5areductase inhibitor before bipolar transurethral resection of the prostate (B-TURP): Evaluation of prostate vascularity and decreased surgical blood loss in large prostates. BJU Int 2015; 116:117e23.
[28]	Nugroho EA, Muslim R, Riwanto I, Author C. The efficacy of dutasteride and green tea combination towards angiogenesis and bleeding on BPH after TURP: Study the effect on VEGF, MVD, and Hb. J Sci Eng 2015; 9:80e4.
[29]	Bansal A, Arora A. 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 microvessel density. J Endourol 2017; 31:910e7.
[30]	Koul SM, Shah I, Khursheed O, Koul SM, Shah M. Role of dutasteride (5-alpha-reductase inhibitor) in patients undergoing transurethral resection of prostrate. Int J Res Med Sci 2018; 6: 2667. https://doi.org/10.18203/2320-6012.ijrms20183248. doi: 10.18203/2320-6012.ijrms20183248
[31]	Rahman M, Johura F-T, Rasul A, Bhuiyan AKMM, Ibrahim Ali M, Hossain S, et al. Effect of preoperative dutasteride on bleeding related to transurethral resection of prostate in patients with benign prostatic hyperplasia. J Biosci Med 2019; 7:157e69.
[32]	Tan ME, Li J, Xu HE, Melcher K, Yong EL. Androgen receptor: Structure, role in prostate cancer and drug discovery. Acta Pharmacol Sin 2015; 36:3e23.
[33]	Kim EH, Brockman JA, Andriole GL. The use of 5-alpha reductase inhibitors in the treatment of benign prostatic hyperplasia. Asian J Urol 2018; 5:28e32.
[34]	Frye S. Discovery and clinical development of dutasteride, a potent dual 5 alpha-reductase inhibitor. Curr Top Med Chem 2006; 6:405e21.
[35]	Marberger M. Drug insight: 5a-reductase inhibitors for the treatment of benign prostatic hyperplasia. Nat Clin Pract Urol 2006; 3:495e503.
[36]	Wurzel R, Ray P, Major-Walker K, Shannon J, Rittmaster R. The effect of dutasteride on intraprostatic dihydrotestosterone concentrations in men with benign prostatic hyperplasia. Prostate Cancer Prostatic Dis 2007; 10:149e54.
[37]	Alder L, Tambe A. Acute anemia. Treasure Island (FL): Stat- Pearls Publishing; 2018. p6.
[38]	Kim KS, Jeong WS, Park SY, Kim YT, Moon HS. The effect of two weeks of treatment with dutasteride on bleeding after transurethral resection of the prostate. World J Mens Health 2015; 33:14e9.
[39]	Marshall S, Narayan P, Mebust WK. Treatment of prostatic bleeding: Suppression of angiogenesis by androgen deprivation. J Urol 1993; 149:1553e4.
[40]	Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int 2000; 85:70e3.
[41]	Zaitsu M, Tonooka A, Mikami K, Hattori M, Takeshima Y, Uekusa T, et al. A dual 5 a -reductase inhibitor dutasteride caused reductions in vascular density and area in benign prostatic hyperplasia. ISRN Urol 2013;2013:863489. https://doi.org/10.1155/2013/863489.
[42]	Canda AE, Mungan MU, Yilmaz O, Yorukoglu K, Tuzel E, Kirkali Z. Effects of finasteride on the vascular surface density, number of microvessels and vascular endothelial growth factor expression of the rat prostate. Int Urol Nephrol 2006; 38:275e80.
[43]	Lattimer C, Perera C. Blood transfusion. Key topics general surgery. Oxford: BIOS Scientific Publishers; 2002. p58e62.
[44]	Ross D, Erkocak O, Rasouli MR, Parvizi J. Operative time directly correlates with blood loss and need for blood transfusion in total joint arthroplasty. Arch Bone Jt Surg 2019; 7:229e34.