An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Xu, Zhunan; Mu, Yingmei; Cai, Tong; Gao, Zhenli; Liu, Lingling

doi:10.3389/fsurg.2021.779571

Cited by 6 publications

(12 citation statements)

References 36 publications

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“…In a systematic review and meta-analysis exclusively of randomized controlled trials, Xu et al demonstrated that while prostate volume and Qmax improvement were greater following TURP, there were no significant differences in terms of IPSS, QoL, and PVR between PAE and TURP. 28 The complication rate was also comparable between PAE and TURP, but the former resulted in a lower rate of sexual dysfunction. Similarly, a recently published Cochrane review suggests that PAE may provide similar improvement in urological symptoms and QoL compared to TURP, but PAE is associated with less ejaculatory disorders.…”

Section: Discussionmentioning

confidence: 80%

The State of Evidence in Prostate Artery Embolization

Qamhawi

Little

2022

Semin intervent Radiol

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Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.

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Section: Discussionmentioning

confidence: 80%

The State of Evidence in Prostate Artery Embolization

Qamhawi

Little

2022

Semin intervent Radiol

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“…One metaanalysis found no statistically significant difference in the adverse effects between PAE and TURP [OR 0.90; 95%CI: 0.20-4.05]. 41 The evidence for adverse events between HoLEP and TURP has been…”

Section: Discussionmentioning

confidence: 99%

“…The IPSS score improvement can be used to quantify the success or failure of BPH treatment 40 . Prior literature has been variable regarding the efficacy of PAE, TURP and HoLEP on IPSS score outcomes, with some studies reporting non‐inferiority between the PAE‐TURP and HoLEP‐TURP 1,9,33,41 . A recent meta‐analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: −0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41 .…”

Section: Discussionmentioning

confidence: 99%

“…Prior literature has been variable regarding the efficacy of PAE, TURP and HoLEP on IPSS score outcomes, with some studies reporting non‐inferiority between the PAE‐TURP and HoLEP‐TURP 1,9,33,41 . A recent meta‐analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: −0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41 . Another meta‐analysis showed an IPSS effect size of MD 2.50 (95%CI: 0.78 to 4.21) in favour of TURP [inferiority of one of the treatments compared] 1 .…”

Section: Discussionmentioning

confidence: 99%

“…1,9,33,41 A recent meta-analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: À0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41. Another meta-analysis showed an IPSS effect size of MD 2.50 (95%CI: 0.78 to 4.21) in favour of TURP [inferiority of one of the treatments compared] 1.…”

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confidence: 99%

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One‐year outcomes after prostate artery embolization versus laser enucleation: A network meta‐analysis

Bhatia,

Porto,

Maini

et al. 2023

BJUI Compass

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BackgroundAlthough holmium laser enucleation (HoLEP) is considered a size‐independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post‐operative and short‐term efficacy of PAE and HoLEP.MethodsPubMed, Cochrane Library and EMBASE databases were searched. Network meta‐analysis was performed following PRISMA‐N‐guidelines. Post‐operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post‐void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared.ResultsQualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: −2.21: 95%CI: (−10.20, 5.78), favouring PAE], QoL score improvement [WMD: −0.22:95%CI: (−1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (−59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1‐year follow‐up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (−1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (−1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (−32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (−2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP‐OR: 0.68, 95%CI: (0.25, 1.37)].ConclusionHoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long‐term outcome of PAE are needed to establish the durability of early outcomes after PAE.

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Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study

Sapoval,

Bhatia,

Déan

et al. 2024

Cardiovasc Intervent Radiol

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Purpose To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). Materials and Methods This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. Results Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. Conclusion PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589. Graphical Abstract

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An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Cited by 6 publications

References 36 publications

The State of Evidence in Prostate Artery Embolization

The State of Evidence in Prostate Artery Embolization

One‐year outcomes after prostate artery embolization versus laser enucleation: A network meta‐analysis

Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study

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