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Using Haemocoagulase Agkistrodon in Patients Undergoing Transurethral Plasmakinetic Resection of the Prostate: A Pilot, Real-World, and Propensity Score-Matched Study. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9200854. [PMID: 35782057 PMCID: PMC9242795 DOI: 10.1155/2022/9200854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/01/2022] [Indexed: 12/30/2022]
Abstract
Objectives To compare the clinical outcomes of using different hemostatic agents after transurethral plasmakinetic resection of the prostate (TUPKP) in benign prostatic hyperplasia (BPH) patients. Methods The patients were divided into 5 groups according to the hemostatic agents used after TUPKP, including the haemocoagulase agkistrodon for injection (HCA), hemocoagulase for injection (HC), hemocoagulase bothrops atrox for injection (HCB), ethylenediamine diaceturate injection (EDD), and tranexamic acid (TXA). Propensity score matching was performed based on age, body mass index, prostate volume, hypertension status, fasting blood glucose, smoking, and drinking history. The hospitalization time, bladder irrigation time, indwelling catheterization time, the patency of urine flow, and blood transfusion records were used as outcome indicators to compare the clinical effects of these five agents. Results We finally matched 65 pairs receiving HCA or HC, 71 pairs receiving HCA or HCB, 38 pairs receiving HCA or TXA, and 29 pairs receiving HCA or EDD. Compared with HC, HCA given during the perioperative period significantly reduced the median hospitalization time [7.00 days (5.00, 8.00) vs. 9.00 days (8.00, 10.00); p < 0.001] and median catheterization time (109.00 hours [88.00, 129.00] vs. 164.00 hours [114.00, 189.00], p < 0.001). Compared with EDD, the median hospitalization time (7.00 days [6.00, 8.00] vs. 10.00 days [8.00, 11.00]; p < 0.001) and median catheterization time (113.00 hours [95.00, 143.00] vs. 160.00 hours [139.00, 168.00]; p < 0.001) were also significant shorter in HCA group. Compared with HCB, median bladder irrigation time (45.00 hours [27.00, 71.00] vs. 49.00 hours [45.00, 72.00]; p = 0.04) was shorter in the HCA group. However, there were no statistical differences in outcomes between HCA and TXA. Conclusions HCA probably has an advantage over HC, HCB, and EDD in reducing the hospitalization time, catheterization time, and bladder irrigation time among BPH patients undergoing TUPKP.
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Kloping YP, Yogiswara N, Azmi Y. The role of preoperative dutasteride in reducing bleeding during transurethral resection of the prostate: A systematic review and meta-analysis of randomized controlled trials. Asian J Urol 2021; 9:18-26. [PMID: 35198393 PMCID: PMC8841297 DOI: 10.1016/j.ajur.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 11/23/2020] [Accepted: 12/09/2020] [Indexed: 11/27/2022] Open
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.
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Kumar N, Palve S, Marripeddi K, Thantla S. Effect of short-term preoperative dutasteride and finasteride on bleeding after transurethral resection of the prostate: A prospective randomized study. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_2_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ali A, Fawzy A, Ramadan E, El-Hawy M, Fathelbab T, Hussein A, Abd Elmalek Hassan M, Alshara L, Tawfiek E. Six weeks finasteride monotherapy before TURP: Does it improve quality of life in early post operative period? AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2018.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bansal A, Arora A. Transurethral Resection of Prostate and Bleeding: A Prospective, Randomized, Double-Blind Placebo-Controlled Trial to See the Efficacy of Short-Term Use of Finasteride and Dutasteride on Operative Blood Loss and Prostatic Microvessel Density. J Endourol 2017. [DOI: 10.1089/end.2016.0696-rev] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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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 micro-vessel density. J Endourol 2017; 31:910-917. [PMID: 29641345 DOI: 10.1089/end.2016.0696] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Ankur Bansal
- Janak Surgicare Centre, Patiala, Punjab, India, patiala, Punjab, India ;
| | - Aditi Arora
- Janak Surgicare Centre, Patiala, Punjab, India, patiala, Punjab, India ;
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Arora A, Bansal A, Purkait B, Sokhal AK, Bhaskar V, Yadav P, Sankhwar S. WITHDRAWN: 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. Urology 2016:S0090-4295(16)30829-9. [PMID: 27864106 DOI: 10.1016/j.urology.2016.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/01/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Aditi Arora
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bansal
- Department of Urology, King George Medical College, Lucknow, Uttar Pradesh, India.
| | - Bimalesh Purkait
- Department of Urology, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Ashok Kumar Sokhal
- Department of Urology, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Ved Bhaskar
- Department of Urology, King George Medical College, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Zhu YP, Dai B, Zhang HL, Shi GH, Ye DW. Impact of preoperative 5α-reductase inhibitors on perioperative blood loss in patients with benign prostatic hyperplasia: a meta-analysis of randomized controlled trials. BMC Urol 2015; 15:47. [PMID: 26032962 PMCID: PMC4450838 DOI: 10.1186/s12894-015-0043-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 05/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability of 5α-reductase inhibitors (5ARIs) to decrease blood loss during transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH) remains controversial. We aimed to conduct a meta-analysis of all randomized controlled trials (RCTs) to establish the role of 5ARI use prior to TURP. METHODS We searched studies from the electronic databases PubMed, Embase, Scopus, and Cochrane Library from inception to March 25, 2014. Meta-analysis was performed using the statistical software Review Manager version 5.1. RESULTS Seventeen RCTs including 1489 patients were examined. We observed that preoperative treatment with finasteride can decrease total blood loss, blood loss per gram of resected prostate tissue, hemoglobin level alteration, microvessel density (MVD), and vascular endothelial growth factor level. Neither finasteride nor dutasteride reduced operative time, prostate volume, or the weight of gland resected. In contrast, pretreatment with dutasteride before TURP did not decrease the total blood loss or MVD. CONCLUSIONS Pretreatment with finasteride does seem to reduce perioperative blood loss related to TURP for BPH patients. However, the effect of preoperative dutasteride was inconclusive. Further studies are required to strengthen future recommendations regarding the use of 5ARI as a standard pre-TURP treatment and its optimal regimen.
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Affiliation(s)
- Yi-Ping Zhu
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China.
| | - Bo Dai
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China.
| | - Hai-Liang Zhang
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China.
| | - Guo-hai Shi
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China.
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong an Road, Shanghai, 200032, People's Republic of China.
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Should Finasteride Be Routinely Given Preoperatively for TURP? ISRN UROLOGY 2013; 2013:458353. [PMID: 23984104 PMCID: PMC3747465 DOI: 10.1155/2013/458353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/19/2013] [Indexed: 11/17/2022]
Abstract
Objective. The aim of the review was to compare the use of finasteride to placebo in patients undergoing TURP procedures. Material & Methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966–November 2011), EMBASE (1980–November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles, and abstracts from conference proceedings without language restriction for studies comparing finasteride to placebo patients needing TURPs. Results. Four randomised controlled trials were included comparing finasteride to a placebo. A meta-analysis was not conducted due to the disparity present in the results between the studies. Three of the studies found that finasteride could reduce either intra- or postoperative bleeding after TURP. One study found finasteride to significantly lower the microvessel density (MVD) and vascular endothelial growth factor (VEGF). None of the studies reported any long-term complications related to either the medication or the procedure.
Conclusion. finasteride reduces bleeding either during or after TURP.
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Kavanagh LE, Jack GS, Lawrentschuk N. Prevention and management of TURP-related hemorrhage. Nat Rev Urol 2011; 8:504-14. [PMID: 21844906 DOI: 10.1038/nrurol.2011.106] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Donohue JF, Hayne D, Karnik U, Thomas DR, Foster MC. Randomized, placebo-controlled trial showing that finasteride reduces prostatic vascularity rapidly within 2 weeks. BJU Int 2005; 96:1319-22. [PMID: 16287453 DOI: 10.1111/j.1464-410x.2005.05849.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure expression of vascular endothelial growth factor (VEGF) and microvessel density (MVD) in the prostates of men after transurethral resection of the prostate (TURP) following 2 weeks of treatment with finasteride. PATIENTS AND METHODS Sixty-four men scheduled to undergo TURP were randomized to receive 5 mg of finasteride or placebo daily for 2 weeks before surgery. Sections of prostatic urothelium were stained for VEGF expression and for CD31 to assess MVD. Ten consecutive, non-overlapping high-power fields were analysed in a blinded fashion. RESULTS In all, 31 men received finasteride and 33 placebo; the groups were similar in patient age, resected prostate weight, preoperative catheterization, prostate-specific antigen level, aspirin use, spinal anaesthesia and postoperative diagnosis of prostate cancer. The mean (95% confidence interval) MVD was significantly lower in the finasteride group (60, 55-65) than in the placebo group (71, 64-78; P < 0.01). Similarly, the mean expression of VEGF was significantly lower in the finasteride group (47, 43-52 vs 61, 54-67; P < 0.001) CONCLUSION Finasteride inhibits angiogenic growth factors leading to reduced vascularity, and this is the basis of its action in reducing haematuria of prostatic origin. The present study shows that finasteride influences the prostatic microvasculature after only 2 weeks exposure.
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Affiliation(s)
- John F Donohue
- Department of Urology, Good Hope Hospital, Birmingham, UK.
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