Dutasteride Reduces TURP-Related Blood Loss

Study results show that dutasteride is similar to the 5α-reductase inhibitor finasteride in its effect on post-operative blood loss in men treated for benign prostatic hyperplasia.

Experts estimate that roughly 5 of every 100 men who undergo transurethral resection of the prostate (TURP-the gold standard treatment for symptomatic benign prostatic hyperplasia) experience post-operative bleeding. Hemorrhage (sometimes prolonged) is possible. It complicates the picture with clot retention that impairs the patient’s ability to void and sometimes creates a need for blood transfusion.

Studies have shown that the 5α-reductase inhibitor finasteride can reduce TURP-related bleeding. A study published in the World Journal of Men’s Health indicates that dutasteride has similar properties, and validates a previous study that also showed this result.

This study hypothesis was based on dutasteride’s mechanism of action: it reduces intraprostatic dihydrotestosterone and prostate tissue vascularity. The researchers assessed perioperative and postoperative bleeding during TURP after pretreatment with dutasteride for two weeks.

They enrolled 83 men with benign prostatic hyperplasia who were eligible for TURP. Of these, 40 patients were treated with dutasteride 0.5 mg/day for two weeks before surgery. The 43 men in the control group did not receive dutasteride or any 5α-reductase inhibitor. The researchers measured blood loss before, immediately after and 24 hours after surgery, and indwelling urethral catheter duration, continuous saline bladder irrigation, and hospitalization.

The dutasteride-treated group experienced significantly lower mean blood loss than the control group immediately after and 24 hours after surgery. After surgery, clinicians order continuous bladder irrigation and urethral Foley catheters use until hematuria ceases. Dutasteride-treated patients had fewer days of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization after TURP.

Patients in both groups had similar PT, aPTT, INR, and bleeding times. This led the researchers to believe that dutasteride affects only affect vascularity-related bleeding during TURP.

The researchers note that clinicians may consider short-term dutasteride preceding scheduled TURP for patients taking aspirin or antiplatelet therapy.

The authors did not look at costs or cost reductions associated with this intervention. Further studies are needed to determine its economic implications.