The Effect Of Preoperative Shot-term High-dose Finasteride On Operative Bleeding During Transurethral Resection Of Prostate

Benign prostatic hyperplasia(BPH) is one of the most common diseaseprocesses affecting the aging male.One of third patients need surgicaltherapy.Transurethal resection of the prostate(TURP) is considered the goldstandard for the surgical management of BPH,but exceed hemorrhage during theTURP is the dangerous factor. Finasteride is a competitive inhibitor of the enzyme 5α-reductase.Manyresearchs report finasteride is most effective in relieving the BPHhematuria,some scholars note preoperative regular finasteride can reduce theblood loss during TURP,but all finasteride time is over 2 weeks. The reportabout short-term high-dose finasteride is rare. In the clinic working we found hemorrage during TURP decreased afterpreoperative short-term high-dose finasteride,but no evidence-based midicineproof. We study this non-regular finasteride prospectively,to evaluate the effect ofpreoperative finasteride on operative bleeding during TURP ,and to study itsmechanism. 25 patients pretreated with finasteride 20mg/d for 5～8 days beforeTURP and 25 patients without such a preoperative management were studiedand compared. The weight of resected prostatic tissue,the operative time and thecalculated operative bleeding volume were recorded. MVD and VEGFexpression were measured by ISH method in prostatic tissue.The apoptosis ofthe prostate cells in the 2 groups were determined by flow cytometry(FCM). Infinasteride group and control group the mean resected prostatic tissue was(27.72±8.88)g and (27.52±4.98)g,respectively(P>0.05)and the meanoperative bleeding (395.48±131.58)ml and (502.08±84.88)ml(P<0.05)and the mean MVD volume 23.4±11.2 and 34.1±9.7(P<0.05),the meanpositive cell count of VEGF were 116.4±37.1 and 214.6±53.4 respectively(P<0.05).Rates of apoptosis were (6.16±2.43)% and (3.62±0.73)%(P<0.05). The preliminary results suggested that VEGF expression andangiogenesis in the prostate tissue are suppressed and blood loss during TURPdecreased by the used of preoperative finasteride. The preopertive prepare timecan be shorten ,and the cost of therapy can be reduced. VEGF can inhibite theapopotosis of prostate cell.From this relation we know finasteride can promotethe apoptosis of the prostate cells and as a result.