RESUMO
OBJECTIVE: Open prostatectomy (OP) is a valid option for the surgical treatment of large prostates in the absence of holmium laser enucleation. The most frequent complication of OP is intra- and perioperative bleeding. Preoperative use of dutasteride has been shown to reduce vascularity and perioperative bleeding in transurethral resection of the prostate (TUR-P). However, there has been no study addresing this effect in OP. The aim of this study was to evaluate whether pretreatment with dutasteride for 6 weeks before OP can reduce surgical blood loss. MATERIAL AND METHODS: Data of 218 patients with benign prostatic hyperplasia (BPH) who underwent OP was investigated retrospectively. Of the 218 patients, 46 were treated with dutasteride for at least 6 weeks and the rest were dutasteride naïve. Age, prostate volume, prostate-specific antigen (PSA) levels, coagulation tests, platelet counts, pre- and postoperative hemoglobin (Hb) levels, and transfusion history were recorded. Blood loss was estimated as follows: preoperative Hb (-) postoperative Hb (+) amount of 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 postoperative Hb levels. Preoperative Hb levels were lower in the dutasteride group (13.4 vs. 14.3, p=0.002) and amount of bleeding (-2.72 g/dL vs. -1.93 g/dL, p= 0.01) was shown to be significantly lower in dutasteride group. CONCLUSION: Our results showed that pretreatment with dutasteride for 6 weeks before OP considerably reduces perioperative surgical bleeding. Further prospective randomized trials should be conducted to confirm the effectiveness of such treatment.
RESUMO
PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6±16.5 years and the mean follow-period was 39±11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.