Meta-analysis of Finasteride for Perioperative Bleeding in Patients Undergoing Transurethral Resection of Prostate_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Yuchun ¹ , ZHONG Ling ² , WEI Qiang ¹

1.Department of Urology,West China Hospital of Sichuan University, Chengdu 610041, China; 2.West China School of Medicine, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Finasteride; Transurethral resection of the prostate; Bleeding; Benign prostatic hyperplasia; Meta-analysis

DOI：

10.7507/1672-2531.20080104

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Objective 　To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP).
Methods 　We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2.
Result 　We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (P gt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group.
Conclusion 　The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.

Citation： ZHU Yuchun,ZHONG Ling,WEI Qiang. Meta-analysis of Finasteride for Perioperative Bleeding in Patients Undergoing Transurethral Resection of Prostate. Chinese Journal of Evidence-Based Medicine, 2008, 08(6): 456-460. doi: 10.7507/1672-2531.20080104 Copy

1.	Dull P, Reagan RW Jr, Bahnson RR, et al. Managing Benign ProstaticHyperplasia. Am Fam Physician, 2002, 66(1): 77-84.
2.	Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
3.	Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6[updated month year]. The Cochrane Library, Issue 4, 2006. Chichester: Wiley. Updated quarterly.
4.	李幼平, 刘鸣. 循证医学—21世纪的临床医学. 实用医学杂志, 2000, 16: 517-521.
5.	Peter Juni, Anne Witschi, Ralph Bloch T, et al. he hazards of scoring the qual ity of cl inical trials for meta-analysis. JAMA, 2000, 282: 1054-1060.
6.	Crea G, Sanfil i ppo G, Anastasi G, et al. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urologia Internationalis, 2005, 74(1): 51-53.
7.	Donohue JF, Sharma H, Abraham R, et al. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss. J Urol, 2002, 168: 2024-2026.
8.	李恭会, 何正富, 余大敏, 等. 非那雄胺对经尿道前列腺切除术中出血和冲洗液吸收影响的定量性研究. 浙江大学学报 (医学版), 2004, 33(3): 258-260.
9.	刘孝东, 杨宇如, 卢一平, 等. 非那雄胺减少TURP术中出血的机理研究. 中华泌尿外科杂志, 2003, 10(24): 694-696.
10.	Ozdal OL, Ozden C, Benl i K, et al. Effect of short-term finasteride therapy on reoperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study. Prostate Cancer Prostatic Dis, 2005, 8(3): 215-218.
11.	Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group: The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med, 1992, 327: 1185-1191.
12.	Marshall S, Narayan P. Treatment of prostatic bleeding: suppression of angiogenesis by androgen deprivation. J Urol, 1993, 149: 1553-1554 .
13.	Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
14.	Hochberg DA, Basillote JB, Armenakas NA, et al. Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia. J Urol, 2002, 167: 1731-1733.
15.	Luke M, Kvist E, Anderson F, et al. Reduc postoperative bleeding after transurethral resectioprostate by local instillation of fibrin adhesive. BeBr J Urol, 1986, 58: 672-675.
16.	Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int, 2000, 85(1): 70-73.
17.	Szewczyk W. Blood loss during transurethral resection of the prostate injected with phenol solution. Int Urol Nephrol, 1991, 23: 155-159.
18.	Levine AC, Liu XH, Greenberg PD, et al. Androgens induce the expression of vascular endothel ial growth factors in human fetal prostatic fibroblasts. Endocrinology, 1998, 139: 4672-4678 .
19.	Franck-Lissbrant I, Haggestrom S, Damber JE, et al. Testosterone stimulates angiogenesis and vascular regrowth in the ventral prostate in castrated adult rats. Endocrinology, 1998, 139: 451-456.
20.	Buttyan R, Ghafar MA, Shabsigh A. The effects ofandrogen deprivation on the prostate gland: cell death mediated by vascular regression. Curr Opin Urol, 2000, 10: 415-420.
21.	Weingartner K, Ben-Sasson S, Stewart R, et al. Endothel ial cell prol iferation activity in benign prostatic hyperplasia and prostate cancer: an in vitro model for assessment. J Urol, 1998, 159: 465-470.
22.	Senger DR, Gall i SJ, Dvorak AM, et al. Tumor cells secrete a vascular permeabil ity factor that promotes accumulation of ascites fluid. Science, 1983, 219(4587): 983-985.
23.	Moon SY, Moon WC, Hak R, et al. Finasteride inhibits angiogenesis and expression of VEGF in human BPH. J Urol, 1998, 159(suppl): 332, abstract 1276.
24.	Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology, 1998, 51: 237-240.

1. Dull P, Reagan RW Jr, Bahnson RR, et al. Managing Benign ProstaticHyperplasia. Am Fam Physician, 2002, 66(1): 77-84.
2. Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
3. Higgins J, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 4.2.6[updated month year]. The Cochrane Library, Issue 4, 2006. Chichester: Wiley. Updated quarterly.
4. 李幼平, 刘鸣. 循证医学—21世纪的临床医学. 实用医学杂志, 2000, 16: 517-521.
5. Peter Juni, Anne Witschi, Ralph Bloch T, et al. he hazards of scoring the qual ity of cl inical trials for meta-analysis. JAMA, 2000, 282: 1054-1060.
6. Crea G, Sanfil i ppo G, Anastasi G, et al. Pre-surgical finasteride therapy in patients treated endoscopically for benign prostatic hyperplasia. Urologia Internationalis, 2005, 74(1): 51-53.
7. Donohue JF, Sharma H, Abraham R, et al. Transurethral prostate resection and bleeding: a randomized, placebo controlled trial of role of finasteride for decreasing operative blood loss. J Urol, 2002, 168: 2024-2026.
8. 李恭会, 何正富, 余大敏, 等. 非那雄胺对经尿道前列腺切除术中出血和冲洗液吸收影响的定量性研究. 浙江大学学报 (医学版), 2004, 33(3): 258-260.
9. 刘孝东, 杨宇如, 卢一平, 等. 非那雄胺减少TURP术中出血的机理研究. 中华泌尿外科杂志, 2003, 10(24): 694-696.
10. Ozdal OL, Ozden C, Benl i K, et al. Effect of short-term finasteride therapy on reoperative bleeding in patients who were candidates for transurethral resection of the prostate (TUR-P): a randomized controlled study. Prostate Cancer Prostatic Dis, 2005, 8(3): 215-218.
11. Gormley GJ, Stoner E, Bruskewitz RC, et al. For the Finasteride Study Group: The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med, 1992, 327: 1185-1191.
12. Marshall S, Narayan P. Treatment of prostatic bleeding: suppression of angiogenesis by androgen deprivation. J Urol, 1993, 149: 1553-1554 .
13. Puchner PJ, Miller MI. The effects of finasteride on hematuria associated with benign prostatic hyperplasia: a prel iminary report. J Urol, 1995, 154: 1779-1782.
14. Hochberg DA, Basillote JB, Armenakas NA, et al. Decreased suburethral prostatic microvessel density in finasteride treated prostates: a possible mechanism for reduced bleeding in benign prostatic hyperplasia. J Urol, 2002, 167: 1731-1733.
15. Luke M, Kvist E, Anderson F, et al. Reduc postoperative bleeding after transurethral resectioprostate by local instillation of fibrin adhesive. BeBr J Urol, 1986, 58: 672-675.
16. Foley SJ, Bailey DM. Microvessel density in prostatic hyperplasia. BJU Int, 2000, 85(1): 70-73.
17. Szewczyk W. Blood loss during transurethral resection of the prostate injected with phenol solution. Int Urol Nephrol, 1991, 23: 155-159.
18. Levine AC, Liu XH, Greenberg PD, et al. Androgens induce the expression of vascular endothel ial growth factors in human fetal prostatic fibroblasts. Endocrinology, 1998, 139: 4672-4678 .
19. Franck-Lissbrant I, Haggestrom S, Damber JE, et al. Testosterone stimulates angiogenesis and vascular regrowth in the ventral prostate in castrated adult rats. Endocrinology, 1998, 139: 451-456.
20. Buttyan R, Ghafar MA, Shabsigh A. The effects ofandrogen deprivation on the prostate gland: cell death mediated by vascular regression. Curr Opin Urol, 2000, 10: 415-420.
21. Weingartner K, Ben-Sasson S, Stewart R, et al. Endothel ial cell prol iferation activity in benign prostatic hyperplasia and prostate cancer: an in vitro model for assessment. J Urol, 1998, 159: 465-470.
22. Senger DR, Gall i SJ, Dvorak AM, et al. Tumor cells secrete a vascular permeabil ity factor that promotes accumulation of ascites fluid. Science, 1983, 219(4587): 983-985.
23. Moon SY, Moon WC, Hak R, et al. Finasteride inhibits angiogenesis and expression of VEGF in human BPH. J Urol, 1998, 159(suppl): 332, abstract 1276.
24. Miller MI, Puchner PJ. Effects of finasteride on hematuria associated with benign prostatic hyperplasia: long-term follow-up. Urology, 1998, 51: 237-240.

Chinese Journal of Evidence-Based Medicine

Meta-analysis of Finasteride for Perioperative Bleeding in Patients Undergoing Transurethral Resection of Prostate

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