Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis

Abstract

Objectives

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.

Methods

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.

Results

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.

Conclusions

Our findings suggest that PAE can reduce moderate to severe LUTS in men with BPH with a low risk of complications.

Key Points

• 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.

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Abbreviations

AUR:

Acute urinary retention

BPH:

Benign prostatic hyperplasia

IPSS:

International Prostate Symptom Score

IIEF-5:

International Index of Erectile Function

LUTS:

Lower urinary tract symptoms

NTE:

Non-target embolisation

PAE:

Prostate artery embolisation

PES:

Post-embolisation syndrome

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-analysis

PSA:

Prostate-specific antigen

PV:

Prostate volume

PVR:

Post-void residual

Qmax:

Peak urinary flow

QoL:

Quality of life

SIR:

Society of Interventional Radiology

TURP:

Transurethral resection of the prostate

UTI:

Urinary tract infection

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Funding

The authors state that this work has not received any funding.

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Correspondence to B. Malling.

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The scientific guarantor of this publication is Professor Lars Lönn.

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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.

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Written informed consent was not required for this study because this was a systematic review and meta-analysis.

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Institutional Review Board approval was not required because this was a systematic review and meta-analysis.

Methodology

• prospective

• systematic review and meta-analysis

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Malling, B., Røder, M.A., Brasso, K. et al. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol 29, 287–298 (2019). https://doi.org/10.1007/s00330-018-5564-2

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Keywords

  • Male
  • Lower urinary tract symptoms
  • Prostatic hyperplasia
  • Embolisation, therapeutic