Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

Xiang, Peng; Guan, Di; Du, Zhaohui; Hao, Yongxiu; Yan, Wei; Wang, Yonghui; Liu, Yutong; Liú, Dan; Ping, Hao

doi:10.1007/s00330-020-07663-2

Cited by 35 publications

(21 citation statements)

References 54 publications

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“…Several studies demonstrated that PAE is able to deliver excellent clinical outcomes in terms of prostate volume reduction, Qmax, PVR, QoL, as well as various standardized questionnaires, such as IPSS, ICIQ-UI, and IIEF [12,20,21]. Regarding changes in prostate MRI over time after PAE, only manual assessments have been performed to date, both with respect to volumetric characteristics and morphologic changes in SIs.…”

Section: Discussionmentioning

confidence: 99%

Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization

et al. 2022

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(1) Background: To assess the treatment response of benign prostatic syndrome (BPS) following prostatic artery embolization (PAE) using a semi-automatic software analysis of magnetic resonance imaging (MRI) features and clinical indexes. (2) Methods: Prospective, monocenter study of MRI and clinical data of n = 27 patients with symptomatic BPS before and (1, 6, 12 months) after PAE. MRI analysis was performed using a dedicated semi-automatic software for segmentation of the central and the total gland (CG, TG), respectively; signal intensities (SIs) of T1-weighted (T1w), T2-weighted (T2w), and diffusion-weighted images (DWI), as well as intravesical prostatic protrusion (IPP) and prostatic volumes (CGV, TGV), were evaluated at each time point. The semi-automatic assessed TGV was compared to conventional TGV by an ellipse formula. International prostate symptom score (IPSS) and international consultation on incontinence questionnaire–urinary incontinence short form (ICIQ-UI SF) questionnaires were used as clinical indexes. Statistical testing in the form of ANOVA, pairwise comparisons using Bonferroni correction, and multiple linear correlations, were conducted using SPSS. (3) Results: TGV was significantly reduced one, six, and 12 months after PAE as assessed by the semi-automatic approach and conventional ellipse formula (p = 0.005; p = 0.025). CGV significantly decreased after one month (p = 0.038), but showed no significant differences six and 12 months after PAE (p = 0.191; p = 0.283). IPP at baseline was demonstrated by 25/27 patients (92.6%) with a significant decrease one, six, and 12 months after treatment (p = 0.028; p = 0.010; p = 0.008). Significant improvement in IPSS and ICIQ-UI SF (p = 0.002; p = 0.016) after one month correlated moderately with TGV reduction (p = 0.031; p = 0.05, correlation coefficients 0.52; 0.69). Apparent diffusion coefficient (ADC) values of CG significantly decreased one month after embolization (p < 0.001), while there were no significant differences in T1w and T2w SIs before and after treatment at each time point. (4) Conclusions: The semi-automatic approach is appropriate for the assessment of volumetric and morphological changes in prostate MRI following PAE, able to identify significantly different ADC values post-treatment without the need for manual identification of infarct areas. Semi-automatic measured TGV reduction is significant and comparable to the TGV calculated by the conventional ellipse formula, confirming the clinical response after PAE.

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Section: Discussionmentioning

confidence: 99%

Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization

et al. 2022

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“…This study also showed that the prostate function-related indicators of the patient at one month and six months after surgery were significantly better than those before surgery, and PV was also significantly decreased. Prostatic arterial embolization can block the blood supply of the enlarged prostate by embolizing bilateral prostatic arteries, which can induce ischemic necrosis and apoptosis of prostate tissue and block the internal circulation of androgen to the prostate tissue, thus improving the therapeutic effect through androgen-related apoptosis ( 25 , 26 ). At the same time, prostatic artery embolization can effectively destroy some prostatic nerves, thus eliminating the increase in smooth muscle tension in BPH patients, thus reducing urethral resistance and increasing urinary flow ( 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Prostatic Artery Embolization in the Treatment of High Risk Benign Prostatic Hyperplasia and its Influence on Postoperative Life Quality of Patients

et al. 2022

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ObjectiveTo evaluate the efficacy, safety and postoperative quality of life of high risk benign prostatic hyperplasia (BPH) patients treated with prostatic artery embolization.Methods34 patients with high-risk BPH were selectedfrom January 2020 to June 2021 in our hospital. All patients were treated with prostatic artery embolization. The changes of international prostate symptom score (IPSS), prostate volume (PV), remaining urine (RU), maximum urine flow rate (Qmax), quality of life scale -74(GQOLI-74), time to sleep without disturbance (HUS) judgment, self-rating anxiety scale (SAS) score and self-rating depression scale (SDS) were compared before operation, 1 month and 6 months after operation.ResultsProstatic artery embolization was successful in all 34 patients, including unilateral embolization in 15 patients and bilateral embolization in 19 patients. No severe complications occurred in the postoperative patients. The IPSS, PV and RU levels of the patient one month and six months after surgery were lower than those before surgery, while the Qmax level was higher than that before surgery. Besides, the IPSS, PV and RU levels six months after surgery were significantly lower than those one month after surgery, and the Qmax level was significantly higher than that one month after surgery (p < 0.05). The GQOLI-74 score six months after surgery was significantly higher than that before surgery (p < 0.05). The HUS of the patient six months after surgery was significantly increased, and the SAS and SDS scores were significantly decreased as compared with those before surgery (p < 0.05).ConclusionFor high-risk patients with BPH, prostate embolization is an effective and safe method, which can significantly improve the quality of life of patients after surgery and has good application prospects.

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“…Points of interest for PAE are mainly centered around overcoming the morbidity associated with invasive procedures. Angioembolization is performed under local anesthesia, doesn't require discontinuing anticoagulants and allows for potentially quicker postprocedure recovery (4,5). Despite a growing body of evidence supporting PAE, there remains controversy about its real-world applications.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, PAE prevents prostate tissue growth and promotes smooth muscle and epithelial cell apoptosis in the prostatic transition zone through artery embolization. PAE was initially developed to treat hematuria, but studies have demonstrated relief in BPH associated LUTS following PAE (4,5). Few studies have assessed surgical effectiveness of PAE compared to validated BPH surgical procedures such as TURP and PUL in a real-world setting.…”

Section: Introductionmentioning

confidence: 99%

Prostatic artery embolization compared to trans-urethral resection of the prostate and prostatic urethral lift: A real-world population-based study

Raizenne¹,

Zheng²,

Oumedjbeur³

et al. 2022

European Urology

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Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

Cited by 35 publications

References 54 publications

Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization

Semi-Automatic MRI Feature Assessment in Small- and Medium-Volume Benign Prostatic Hyperplasia after Prostatic Artery Embolization

Efficacy and Safety of Prostatic Artery Embolization in the Treatment of High Risk Benign Prostatic Hyperplasia and its Influence on Postoperative Life Quality of Patients

Prostatic artery embolization compared to trans-urethral resection of the prostate and prostatic urethral lift: A real-world population-based study

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