Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis
- 3.2k Downloads
To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia.
We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL).
All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q max), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria.
TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.
KeywordsEmbolization/embolisation/embolotherapy Therapy Prostate Urinary tract
Benign prostatic hyperplasia
Bladder contractility index
Bladder outlet obstruction
Bladder outlet obstruction index
Detrusor muscle pressure
Digital rectal examination
Digital subtraction angiography
Inferior vesical artery
Institutional review board
International index of erectile function
International prostate symptom score
Lower urinary tract symptoms
Magnetic resonance imaging
Maximum urinary flow rate
Original PAE method
Post-void residual urine volume
Prostate artery embolization
Prostate specific antigen
Proximal embolization first then embolize distal method of PAE
Quality of life
Transurethral resection of the prostate
The authors thank Vanessa Cristina de Paula Rodrigues, Sardis Honoria Harward, and Andre Moreira de Assis for their important collaboration.
Compliance with Ethical Standards
Conflict of interest
Authors declare they have no financial disclosure.
- 6.Antunes AA, Carnevale FC, da Motta Leal Filho JM, Yoshinaga EM, Cerri LM, et al. Clinical laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia: a prospective single-center pilot study. Cardiovasc Interv Radiol. 2013;36(4):978–86.CrossRefGoogle Scholar
- 9.Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary tract symptoms secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23(9):2561–72.PubMedCrossRefGoogle Scholar
- 18.National Cancer Institute. Common terminology criteria for adverse events v4.0. NIH publication # 09-7473. May 29, 2009.Google Scholar
- 23.Carnevale FC, da Motta Leal Filho JM, Antunes AA, Baroni RH, Marcelino ASZ, Cerri LMO, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24:535–42.PubMedCrossRefGoogle Scholar