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

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.

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Fig. 1

Abbreviations

BPH:

Benign prostatic hyperplasia

BCI:

Bladder contractility index

BOO:

Bladder outlet obstruction

BOOI:

Bladder outlet obstruction index

CT:

Computed tomography

P det :

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

Q max :

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

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Acknowledgments

The authors thank Vanessa Cristina de Paula Rodrigues, Sardis Honoria Harward, and Andre Moreira de Assis for their important collaboration.

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Correspondence to Francisco C. Carnevale.

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Carnevale, F.C., Iscaife, A., Yoshinaga, E.M. et al. 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. Cardiovasc Intervent Radiol 39, 44–52 (2016). https://doi.org/10.1007/s00270-015-1202-4

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Keywords

  • Embolization/embolisation/embolotherapy
  • Therapy
  • Prostate
  • Urinary tract