To evaluate the impact of four weeks of treatment with dutasteride on reducing the intra & post-operative bleeding, amount and duration of irrigation needed to clear the haematuria and lower urinary tract symptoms improvement after transurethral resection of the prostate (TURP) larger than 50 gm in men receiving the antiplatelet drug (APD).

This is a randomized clinical trial including 60 male patients who had large prostates indicated for TURP and were under ongoing antiplatelet drugs. It was carried out over a period of 12 months. Full laboratory investigations were done for all patients. Also, abdomen and pelvis ultrasounds showing prostate size and post voiding residual urine , Prostate specific antigen (PSA) and international prostate symptoms score (IPSS) were done. The patients were divided into 2 groups, Group A (dutasteride group) included 30 patients who underwent bipolar TURP after receiving dutasteride for 4 weeks before surgery. Group B (control group) included 30 patients who underwent bipolar TURP without receiving any treatment for benign prostatic hyperplasia (BPH) 4 weeks before surgery.

Both groups showed significant reduction in IPSS postoperatively but there was no significant difference between both groups regarding postoperative IPSS (5.10±1.61 vs  5.07±1.60, P= 0.874) for Group A and Group B respectively (Table 1). Lower mean blood loss was insignificant between the patients’ group (Group A) and the control group (Group B) immediately after and 24 hours after surgery (Δ Hemoglobin HB =1.41±0.63g/dL vs 1.48±0.54g/dL, 2.12±0.70 g/dL vs 2.31±0.78 g/dL respectively,p=0.631,p=0.333); (Δ Hematocrit HCT=2.97±1.51% vs 3.16±1.36%, 4.96±1.87 % vs 5.73±4.39 % respectively, p= 0.610,p= 0.380) (Table 2).  However, there was significant differences in days of indwelling urethral catheter use (5.10±0.55 d vs 5.80±1.79 d, p=0.048), time of bladder irrigation per hour (13.60±2.85 hr vs 16.33±6.62 hr, p=0.044) and the amount of saline for bladder irrigation per litre (11.03±2.30 L vs 13.87±6.13 L, P=0.046) in Group A and Group B respectively (Table 1).

There was no additional value of preoperative dutasteride on the functional outcome of TURP in patients with large prostate and on anti platelet drugs. However the dutasteride may speed up the recovery and shorten the hospital stay in those patients.

Dutasteride for 4 weeks before TURP for large prostate in men receiving APD doesn't significantly reduce the intra and post-operative bleeding after TURP, but significantly reduce the time of indwelling catheterization, duration and amount of irrigation used for clear haematuria. In addition, the dutasteride has no impact on the functional outcome of TURP in the large prostates [1]

Annika Ruhle, Jennifer Blarer, Florian Oehme, et al. Safety and Effectiveness of Bipolar Transurethral resection of the Prostate in patients Undergoing Oral anticoagulation with Coumarins and Antiplatelet Drug Therapy Compared to Patients Without Anticoagulation/Antiplatelet Therapy. J Endourol 2019 Jun;33(6):455-462. doi: 10.1089/end.2018.0879. Epud 2019 Apr 4.