Role of Dutasteride in reducing the complications of trans urethral resection of prostate.

INTRODUCTION : Prostate is one of the major accessory sex gland of male reproductive system. The prostate is a pyramidal shaped fibromuscular glandular organ and it surrounds the prostatic urethra from the bladder base to the external urethral sphincter. The prostate was initially divided into five anatomical lobes in fetal life before the 20 weeks of gestation and it has anterior, posterior, lateral and middle lobe. In normal adult male only three lobes are present which includes two lateral lobes which can be palpated via the rectum and a median lobe which projects normally into the urethra raising a prominence on its floor and produce crista urethralis or verumontanum. Prostate has exocrine functions and doubtful endocrine function. Prostate secretes about 0.5 ml of the total 3ml seminal fluid. It produce many important secretory proteins like prostate specific antigen (PSA) and acid phosphataset. These two proteins are very useful in patients with carcinoma prostate evaluations. As the age increases prostate continue to enlarge in size under the influence of dihydrotestosterone and testosterone. Enlargement of the prostate can lead to bladder outlet obstruction and produce lower urinary tract symptoms (LUTS). Because of the its age dependent illness, the exact prevalence and incidence of BPH cannot be quantified.BPH prevalence is greater than 50% by the 6th decade and by the 8th decade BPH prevalence is as high as 90%.As the age increases, bother some symptoms also tends to increase with age and affects the quality of life. Prostate enlargement in old age was mentioned by various names which include benign prostatic hyperplasia (BPH), benign prostatic enlargement (BPE), or benign prostatic obstruction (BPO), benign prostatic hypertrophy, etc. Prostate enlargement produce wide variety of symptoms which are known as lower urinary tract symptoms. AIM AND OBJECTIVE : The primary aim and objective of the present study is to determine whether preoperative treatment with Dutasteride decreases surgical blood loss in patients who undergo transurethral resection of the prostate for benign prostatic hyperplasia with prostate >30cc volume with acute urinary retention. The secondary objective is to assess the postoperative complication like clot retention, blood transfusion, failure to void after the catheter removal and the urinary tract infection in post operative period. MATERIALS & METHODS : Patients were randomized into three groups of 50 each to undergo TURP. Group 1 - receiving placebo for two weeks preoperatively and two weeks postoperatively. Group 2 - receiving Tab.Dutasteride 0.5mg BD, for 2weeks preoperatively and two weeks postoperatively Group 3-receiving Tab.Finasteride 5mg BD, two weeks preoperatively and 2 weeks postoperatively. Monopolar TURP was done with single stem TUR loop and Glycine as a irrigant. The settings employed was 110W cutting and 80W coagulation for the resection. The setup of instruments for TURP resection, includes 24 – Fr. Karl Storz non-continuous flow sheath with blind and visual obturator, resectoscope, monopolar loop, high frequency cord, 30 degree Karl Storz telescope and unipolar diathermy.Inclusion criteria: Men with Benign prostate enlargement and prostate volume more than 30cc with acute urinary retention who are undergoing TURP. Exclusion criteria: H/O prostatic surgery in the past, Prostatic disease other than BPH, Who had 5Alpha reductase in the past 12 months, Requirement of Aspirin, NSAIDS during the restricted periods, Bleeding disorder, Liver diseases. CONCLUSION : The present study shows two weeks preoperative Dutasteride 0.5 mg BD treatment in BPH will reduce the microvessel density in suburethral portion of prostatic urothelium. Preoperative Dutasteride will helpful for the larger amount of prostatic tissue resection in lesser time. Eventhough the preoperative Haemoglobin and PCV were not significantly different from postoperative Hb/PCV, Dutasteride cause clot retention and blood transfusion in lesser number of post TURP patients. When the Dutasteride is compared with Finasteride in reducing the TURP complication, it has efficacy almost similar to the Finasteride. Preoperative Dutastride will reduce the TURP complication in BPH as Finasteride but needs further large randomized trials to confirm the efficacy with better statistically significant difference