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CardioVascular and Interventional Radiology

, Volume 39, Issue 1, pp 44–52 | Cite as

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

  • Francisco C. Carnevale
  • Alexandre Iscaife
  • Eduardo M. Yoshinaga
  • Airton Mota Moreira
  • Alberto A. Antunes
  • Miguel Srougi
Clinical Investigation

Abstract

Purpose

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.

Methods

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).

Results

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.

Conclusions

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.

Keywords

Embolization/embolisation/embolotherapy Therapy Prostate Urinary tract 

Abbreviations

BPH

Benign prostatic hyperplasia

BCI

Bladder contractility index

BOO

Bladder outlet obstruction

BOOI

Bladder outlet obstruction index

CT

Computed tomography

Pdet

Detrusor muscle pressure

DRE

Digital rectal examination

DSA

Digital subtraction angiography

ED

Erectile dysfunction

IVA

Inferior vesical artery

IVO

Infravesical obstruction

IRB

Institutional review board

IIEF-5

International index of erectile function

IPSS

International prostate symptom score

LUTS

Lower urinary tract symptoms

MRI

Magnetic resonance imaging

Qmax

Maximum urinary flow rate

oPAE

Original PAE method

PVR

Post-void residual urine volume

PAE

Prostate artery embolization

PSA

Prostate specific antigen

PErFecTED

Proximal embolization first then embolize distal method of PAE

QoL

Quality of life

TRUS

Transrectal ultrasound

TURP

Transurethral resection of the prostate

Notes

Acknowledgments

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.

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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2015

Authors and Affiliations

  • Francisco C. Carnevale
    • 1
    • 3
  • Alexandre Iscaife
    • 2
  • Eduardo M. Yoshinaga
    • 2
  • Airton Mota Moreira
    • 1
  • Alberto A. Antunes
    • 2
  • Miguel Srougi
    • 2
  1. 1.Interventional Radiology UnitUniversity of Sao Paulo Medical SchoolSao PauloBrazil
  2. 2.Division of UrologyUniversity of Sao Paulo Medical SchoolSao PauloBrazil
  3. 3.Sao PauloBrazil

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