EFFECT OF DUTASTERIDE (5 ALPHA-REDUCTASE INHIBITOR) TREATMENT ON REDUCING BLOOD LOSS, IN PERIOPERATIVE PERIOD OF OPEN PROSTATECTOMY DONE IN LARGE PROSTATE.

Abstract

Objective- Open prostatectomy (OP) is still a very valid option in treatment of very large volume prostates in the absence of holmium laser enucleation ( holmium laser is a rarity and expensive in govt and self funded medical colleges), its main complication being intra and perioperative bleeding. Preoperative use of dutasteride has shown to decrease perioperative bleeding in TURP (transurethral resection of prostate), though till date OP being a standard procedure in large prostate management ,there is no study showing effect of dutasteride in perioperative bleeding in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP could reduce blood loss in surgery, as high watt holmium laser is still not available in most of the medical colleges ,treating patients for free . Material and Methods- Data of 218 patients who underwent OP for BPH (benign prostatic hyperplasia), were investigated retrospectively. Of 218 patients ,46 were pretreated with dutasteride for 6 weeks and the rest were not under dutasteride treatment. Age, prostate volume , prostate specific antigen(PSA) levels, coagulation profile, platelet count, pre and post operative hemoglobin(Hb) levels ,and blood transfusion history were recorded .Blood loss was estimated as follows : pre operative Hb(-) post operative Hb(+) amount of blood transfusion. The 2 groups were compared by independent samples t-test and a p value of 0.05 was considered significant. Results- The groups were similar in terms of age , prostate volume ,platelet counts, coagulation tests and post operative Hb levels. Preoperative Hb levels were lower in dutasteride group (13.4 vs 14.3,p=0.002) and amount of bleeding (-2.72g/dl vs.-1.93g/dl, p=0.01) was shown to be significantly lower in dutasteride group. Conclusion -Our result showed that pretreatment with dutasteride for 6 weeks before OP for very large prostates, reduces perioperative bleeding , and can be used in medical colleges where treatment is free ,instead of using holmium laser, though further prospective randomized trials would support the effectiveness of such treatment.