Research Paper Volume 12, Issue 5 pp 4337—4347

Surgical blood loss during holmium laser enucleation of the prostate (HoLEP) is not affected by short-term pretreatment with dutasteride: a double-blind placebo-controlled trial on prostate vascularity

Gian Maria Busetto1, , Francesco Del Giudice1, , Martina Maggi1, , Gabriele Antonini1, , Daniele D’Agostino2, , Daniele Romagnoli2, , Alessandro Del Rosso2, , Marco Giampaoli2, , Paolo Corsi2, , Katie Palmer3, , Matteo Ferro4, , Giuseppe Lucarelli5, , Daniela Terracciano6, , Ottavio De Cobelli4, , Alessandro Sciarra1, , Ettore De Berardinis1, , Angelo Porreca2, ,

  • 1 Department of Urology, Sapienza Rome University Policlinico Umberto I, Rome, Italy
  • 2 Department of Urology, Policlinico Abano Terme, Abano Terme (PD), Italy
  • 3 Department of Internal Medicine and Geriatrics, University Cattolica del Sacro Cuore, Rome, Italy
  • 4 Department of Urology, Istituto Europeo di Oncologia (IEO), Milan, Italy
  • 5 Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
  • 6 Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

Received: December 16, 2019       Accepted: February 5, 2020       Published: March 11, 2020
How to Cite

Copyright © 2020 Busetto et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Five α-reductase inhibitors (5ARIs) are able to reduce prostate volume and are a useful treatment for reducing perioperative bleeding during prostate surgery. Holmium laser enucleation of the prostate (HoLEP) is an effective surgical technique for the definitive cure of benign prostate enlargement.

We investigated whether pretreatment with dutasteride before HoLEP could reduce intraoperative bleeding. A total of 402 patients were included in this double-blind placebo-controlled trial to receive daily 0.5 mg of dutasteride or placebo over 8 weeks before HoLEP. Vascular endothelial growth factor (VEGF) and microvascular density (MVD) were evaluated. Analysis was also stratified according to prostate volume (<70 mL vs ≥70 mL).

Hemoglobin and hematocrit values before and after surgery were not statistically different between the two groups. MVD and VEGF index in smaller prostates were 23.35±1.96 and 4.06±0.76 in the treatment group and 19.04±0.96 and 2.55±0.55 in placebo (p<0.05); in patients with larger prostates MVD and VEGF were 26.83±2.812 and 8.54±1.18 in the treatment group and 20.76±0.79 and 3.21±0.54 in placebo (p<0.05).

Vascularization of the prostate was affected by 5ARIs therapy. HoLEP is less burdened in perioperative bleeding and for this reason we did not find any difference in hemoglobin/hematocrit values pre- and post- surgery.


5ARIs: 5α-reductase inhibitors; HoLEP: Holmium laser enucleation of the prostate; LUTS: lower urinary tracts symptoms; MVD: Microvascular density; PSA: Prostate Specific Antigen; TURP: Trans-urethral resection of the prostate; VEGF: Vascular endothelial growth factor.