الفهرس 
Title : The effect of two weeks of treatment with 5 alpha reductase inhibitor on reducing intra & post- operative bleeding, amount and duration of irrigation needed to clear hematuria after transurethral resection of prostate
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Abstract
ntroduction: Benign prostatic hyperplasia (BPH) is the most common cause of the lower urinary tract symptoms (LUTS) in aging men (Sirinivasan A., et. al., 2019). However,
transurethral resection of the prostate (TURP) is still the gold-standard procedure for the
treatment of LUTS-BPH but it is not free of complications (Rubio C.C., et. al., 2019). 5alpha
reductase inhibitor affects the prostate by reducing intraprostatic dihydrotestosterone and
prostate tissue vascularity (Azzouni et al., 2012).
Many studies reported that pretreatment with 5 alpha reductase inhibitor for long period
before TURP reduced surgical bleeding, prostate volume, and the weight of the resected
prostate.
Aim: We evaluated the effect of pretreatment with 5 alpha reductase inhibitor for two weeks
on reducing intraoperative and postoperative bleeding during transurethral resection of the
prostate (TURP) & improving postoperative care including decreased amount and duration of
irrigation needed to clear hematuria.
Patients and Method: This is a prospective randomized clinical trial study including sixty
patients who were done at the urology department of Kasr Al-Ainy hospitals, Cairo
University for six months. Full laboratory investigations were done for all patients. Also,
transrectal ultrasounds showing prostate size, PSA and IPSS score were done and assessed.
The patients were divided into two groups, group A(patients group) included thirty patients
who underwent bipolar transurethral resection of the prostate (TURP) after receiving 5 alpha
reductase inhibitor drug for two weeks before surgery. group B (control group) included
thirty patients who underwent bipolar transurethral resection of the prostate (TURP) without
receiving any treatment two weeks before surgery.
Results: Mean blood loss was insignificant between the patients’ group (group A) and the
control group (group B) immediately after and 24 hours after surgery. Hemoglobin DROP day
zero between group A and group B (ΔHb=1.41±0.63g/dL vs 1.48±0.54g/dL) P=0.631),
Hemoglobin DROP day one between group A and group B (2.12±0.70 g/dL vs 2.31±0.78 g/dL),
P=0.333); Hematocrit DROP day zero between group A and group B (ΔHCT=2.97±1.51% vs
3.16±1.36%) P= 0.610), Hematocrit DROP day one between group A and group B (4.96±1.87 % vs
5.73±4.39 %) P= 0.380). In addition, there is no significant difference in, days of the
indwelling urethral catheter (5.10±0.55d vs 5.10±0.55d, P=1.000), continuous saline bladder
irrigation per hour (13.60±2.85 hrs vs 14.97±3.68 hrs, P=0.113), hospitalization after TURP
(2.1±0.55d vs 2.1±0.55d, P=1.000), amount of saline per liter (11.03±2.30L vs 11.37±2.66L,
P=0.605), and time of operation per minutes (77.00±10.05min vs 76.33±10.25min, P=0.800)
in group A and group B respectively. Two patients received a blood transfusion in group A
(6.7%) compared to three patients in group B (10%) (P=0.640).
Conclusion: Preoperative treatment with 5-ARI for two weeks before TURP does not
significantly reduce surgical intra, post-operative bleeding or hospital stay after TURP, also
does not significantly reduce the time of operation, duration, and amount of saline used to
clear hematuria. According to this study, receiving this treatment for just two weeks does not
make a significant difference in perioperative parameters and may need a longer period.