Preoperative treatment with 5α-reductase inhibitors and the risk of hemorrhagic events in patients undergoing transurethral resection of the prostate – A population-based cohort study

Abstract

OBJECTIVES:To assess the associations between preoperative treatment with 5-alpha reductase inhibitors and the risks of blood transfusion during transurethral resection of the prostate and blood clot evacuation or emergency department visits for hematuria within 1 month after surgery.METHODS:We used data from the Taiwan National Health Insurance Research Database in this population-based cohort study. A total of 3,126 patients who underwent first-time transurethral resection of the prostate from 2004 to 2013 were identified. Adjusted odds ratios estimated by multiple logistic regression models were used to assess the independent effects of the preoperative use of 5-alpha reductase inhibitors on the risks of perioperative hemorrhagic events after adjustment for potential confounders.RESULTS:Two hundred and ninety-seven (9.4%) patients were treated with 5-alpha reductase inhibitors for <3 months, and 65 (2.1%) patients were treated for ≥3 months prior to undergoing transurethral resection of the prostate. The blood transfusion rates for patients who were not treated with 5-alpha reductase inhibitors (controls), patients who were treated with 5-alpha reductase inhibitors for <3 months, and patients who were treated with 5-alpha reductase inhibitors ≥3 months were 9.5%, 8.8%, and 3.1%, respectively. 5-alpha reductase inhibitors tended to decrease the risk of blood transfusion; however, this association was not statistically significant (adjusted odds ratio=0.14, 95% confidence interval: 0.02-1.01). Age ≥80 years, coagulopathy, and a resected prostate tissue weight >50 g were associated with significantly higher risks of blood transfusion than other parameters.CONCLUSIONS:This nationwide study did not show that significant associations exist between 5-alpha reductase inhibitor use before transurethral resection of the prostate and the risks of blood transfusion and blood clot evacuation or emergency visits for hematuria.

A multivariate regression parametric study on DEM input parameters of free-flowing and cohesive powders with experimental data-based validation

“…The absence of d S as an effective factor to the AoR ensures the correct implementation of the coarse-graining scheme proposed by Bierwisch in our system. Moreover, our results contradict many studies which proved that the particle size has an impact on the AoR [22,25,47]. Figure 9 illustrates the Pareto graph of effects on the AoR of the free-flowing powder where the largest positive effects are shown on the left and the largest negative effects on the right, with factors of smaller estimated effects in the middle of the graph.…”

“…The AoR is defined as the slope of a poured conical pile of loose uncompacted bulk solid material [18]. It is a characteristic related to the cohesiveness of the powder [47] and used as a common method to characterize powders according to their flowability [48][49][50][51]. It is a common method to calibrate DEM simulation parameters, where the angle at which a heap of powder settles depends on the strength of the interparticulate friction.…”

“…flowability [62]. It is a measurement of the relative difference between tapped volume and untapped volume of the powder [47], i.e.…”

A Semi-Automated DEM Parameter Calibration Technique of Powders Based on Different Bulk Responses Extracted from Auger Dosing Experiments

“…The AoR prescribes the slope of a discharged conical heap of loose bulk solid material (Marigo et al, 2014). It represents a cohesiveness characteristic of a powder (Zhou and Qiu, 2010). It is widely a familiar method to characterize powders according to their flowability (Krantz et al, 2009;Lumay et al, 2012).…”

The effect of short-term use of finasteride versus cyproterone acetate on perioperative blood loss with monopolar transurethral resection of prostate

“…The gold standard surgical management of benign prostatic hypertrophy (BPH) is transurethral resection of prostate (TURP), although it is accompanied by some morbidity. Absorption of irrigation fluid and perioperative blood loss are the most common complications related to TURP especially with markedly enlarged prostate, and many previous studies showed that perioperative blood loss with TURP can be reduced by preoperative administration of finasteride that act by decreasing dihydrotestosterone level [1][2][3][4].…”