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Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

  • Review
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH).

Materials and Methods

A multi-database search for relevant literature was conducted on 15 July 2020 to include studies published on or before that date. Search terms used were: (prostate embolization OR prostatic embolization OR prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction). Risk of bias was assessed using Cochrane Collaboration and ROBINS-I criteria. Random-effects meta-analysis was performed using RevMan 5.3.

Results

Six studies with 598 patients were included. TURP was associated with significantly more improvement in maximum urinary flow rate (Qmax) (mean difference = 5.02 mL/s; 95% CI [2.66,7.38]; p < 0.0001; I2 = 89%), prostate volume (mean difference = 15.59 mL; 95% CI [7.93,23.25]; p < 0.00001; I2 = 88%), and prostate-specific antigen (PSA) (mean difference = 1.02 ng/mL; 95% CI [0.14,1.89]; p = 0.02; I2 = 71%) compared to PAE. No significant difference between PAE and TURP was observed for changes in International Prostate Symptoms Score (IPSS), IPSS quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), and post-void residual (PVR). PAE was associated with fewer adverse events (AEs) (39.0% vs. 77.7%; p < 0.00001) and shorter hospitalization times (mean difference = −1.94 days; p < 0.00001), but longer procedural times (mean difference = 51.43 min; p = 0.004).

Conclusion

Subjective symptom improvement was equivalent between TURP and PAE. While TURP demonstrated larger improvements for some objective parameters, PAE was associated with fewer AEs and shorter hospitalization times.

Level of Evidence II

Level 2a, Systematic Review

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Radiology, Section of Interventional Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL, 60611, USA

    Gabriel M. Knight, Abhinav Talwar, Riad Salem & Samdeep Mouli

  2. Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL, USA

    Riad Salem & Samdeep Mouli

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  1. Gabriel M. Knight
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  2. Abhinav Talwar
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  4. Samdeep Mouli
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Correspondence to Riad Salem.

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Knight, G.M., Talwar, A., Salem, R. et al. Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 44, 183–193 (2021). https://doi.org/10.1007/s00270-020-02657-5

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  • DOI: https://doi.org/10.1007/s00270-020-02657-5

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