Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis
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Prostate artery embolisation (PAE) is a new minimally invasive treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). The purpose of this study was to review the efficacy and safety of PAE in the treatment of BPH with LUTS.
A systematic review performed according to the PRISMA guidelines with a pre-specified search strategy for PubMed, Web of Science, Cochrane Library and Embase databases protocol (PROSPERO ID: CRD42017059196). Trials studying the efficacy of prostate artery embolisation to treat LUTS with more than ten participants and follow-up longer than 6 months were included by two independent authors. Outcomes investigated were International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR) and complications. To summarise mean change from baseline, a meta-analysis was done using the random-effects model.
The search returned 210 references, of which 13 studies met the inclusion criteria, representing 1,254 patients. Patients in the included studies with data available for meta-analysis had moderate to severe LUTS and a mean IPSS of 23.5. Statistically significant (p value < 0.05) improvements of all investigated outcomes were seen at 12-month follow-up. Major complications were reported in 0.3% of the cases.
Our findings suggest that PAE can reduce moderate to severe LUTS in men with BPH with a low risk of complications.
• Prostate artery embolisation (PAE) improved International Prostate Symptom Score (IPSS) by 67%.
• Major complications after PAE are very rare.
• Use of cone-beam CT may reduce risk of non-target embolisation.
KeywordsMale Lower urinary tract symptoms Prostatic hyperplasia Embolisation, therapeutic
Acute urinary retention
Benign prostatic hyperplasia
International Prostate Symptom Score
International Index of Erectile Function
Lower urinary tract symptoms
Prostate artery embolisation
Preferred Reporting Items for Systematic Reviews and Meta-analysis
Peak urinary flow
Quality of life
Society of Interventional Radiology
Transurethral resection of the prostate
Urinary tract infection
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Professor Lars Lönn.
Conflict of interest
The authors of this manuscript declare relationships with the following companies: Lars Lönn, Medical Director, Mentice.
Statistics and biometry
One of the authors has significant statistical expertise.
Written informed consent was not required for this study because this was a systematic review and meta-analysis.
Institutional Review Board approval was not required because this was a systematic review and meta-analysis.
• systematic review and meta-analysis
- 14.Malling B (2016) Prostatic artery embolisation for benign prostatic hyperplasia: a systematic review. PROSPERO: International prospective register of systematic reviews. Available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=59196
- 15.Covidence systematic review software, Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org
- 16.Higgins JPT, Sterne JAC, Savović J, Page MJ, Hróbjartsson A, Boutron I, Reeves B, Eldridge S (2016) A revised tool for assessing risk of bias in randomized trials. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD201601
- 18.Angle JF, Siddiqi NH, Wallace MJ et al (2010) Quality improvement guidelines for percutaneous transcatheter embolisation: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol JVIR 21:1479–1486. https://doi.org/10.1016/j.jvir.2010.06.014 CrossRefPubMedGoogle Scholar
- 20.R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. URL http://www.R-project.org
- 21.Lumley T (2012) rmeta: meta-analysis. R package version 2.16. https://CRAN.R-project.org/package=rmeta
- 27.Li Q, Duan F, Wang M-Q et al (2015) Prostatic arterial embolisation with small sized particles for the treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia: preliminary results. Chin Med J (Engl) 128:2072–2077. https://doi.org/10.4103/0366-6999.161370 CrossRefGoogle Scholar
- 28.Rampoldi A, Barbosa F, Secco S et al (2017) Prostatic artery embolisation as an alternative to indwelling bladder catheterization to manage benign prostatic hyperplasia in poor surgical candidates. Cardiovasc Intervent Radiol 40:530–536. https://doi.org/10.1007/s00270-017-1582-8 CrossRefPubMedGoogle Scholar
- 31.de Assis AM, Moreira AM, de Paula Rodrigues VC et al (2015) Prostatic artery embolisation for treatment of benign prostatic hyperplasia in patients with prostates > 90 g: a prospective single-center study. J Vasc Interv Radiol JVIR 26:87–93. https://doi.org/10.1016/j.jvir.2014.10.012 CrossRefPubMedGoogle Scholar
- 34.Carnevale FC, Iscaife A, Yoshinaga EM et al (2016) Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolisation (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Intervent Radiol 39:44–52. https://doi.org/10.1007/s00270-015-1202-4 CrossRefPubMedGoogle Scholar
- 35.Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae CrossRefPubMedPubMedCentralGoogle Scholar
- 36.National Cancer Institute Common Terminology Criteria for Adverse Events v4.0 NCI, NIH, DHHS (2009) NIH publication no. 09-7473. National Institutes of Health, BethesdaGoogle Scholar
- 39.Pisco JM, Tinto HR, Pinheiro LC et al (2013) Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 23:2561–2572. https://doi.org/10.1007/s00330-012-2714-9 CrossRefPubMedGoogle Scholar
- 42.Ahyai SA, Gilling P, Kaplan SA et al (2010) Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol 58:384–397. https://doi.org/10.1016/j.eururo.2010.06.005 CrossRefPubMedGoogle Scholar