الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
TURP is the ‘gold standard’ technique for managing BPH. Even within the era of lasers and bipolar vapourisation systems, monopolar TURP is still widely used,especially in developing countries. Despite marked improvements in TURP techniques, bleeding is still one of the undesirable perioperative events.
To provide a strategy for decreasing blood loss, many researchers have focused on the natural history and pathophysiology of BPH-associated bleeding. Abnormal angiogenesis is considered to be the cause of BPH-related haemorrhage. It has been found that using 5a-reductase inhibitors (5ARIs) leads to decreased prostatic bleeding in patients with BPH and those undergoing BPH-related surgery. A reduction in prostatic microvessel density (MVD) has been suggested as the mechanism of action.
Cyproterone acetate is a synthetic steroidal antiandrogen that acts mainly via competitive inhibition of androgen receptors. Also, it has some progestogenic properties that lead to suppression of gonadotrophins and thereby lowering plasma testosterone level. Cyproterone acetate has the advantage of immediate effectiveness. It is usually used for androgen blockade in cases of advanced or metastatic prostate cancer.
In our study we assessed the operative blood loss by comparing hemoglobin level before and 24 hours after the procedure . Our results showed that intraoperative bleeding was significantly reduced after CPA intake for 2 weeks before the surgery. There is also a significant reduction in microvessel density in prostatic tissue in the CPA group compared to the untreated group.
Moreover, Operative time was significantly reduced in the CPA group in comparison to the untreated group. This can be explained by a clearer operative field due to minimal bleeding, allowing more resection in less operative time with less blood loss. Besides that Cyproterone acetate was well tolerated by all our patients with no major side effects and none of the participant had discontinued it.