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Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Objective

To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points.

Methods

PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model.

Results

Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (− 0.44 to 5.09)) and quality of life (0.18 (− 0.41 to 0.77)) at 12 months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24 months.

Conclusion

PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24 months without causing serious complications.

Key Points

• PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times.

• PAE is inferior to TURP in the improvement of most functional outcomes.

• Improvements due to PAE are durable during follow-up to 24 months.

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Abbreviations

BPH:

Benign prostatic hyperplasia

IIEF:

International Index of Erectile Function

IPSS:

International Prostate Symptom Score

LUTS:

Lower urinary tract symptoms

Mo:

Month

PAE:

Prostatic artery embolization

PSA:

Prostate-specific antigen

PUL:

Prostatic urethral lift

PV:

Prostate volume

PVR:

Postvoid residual volume

Qmax:

Maximum flow rate

Qol:

Quality of life

RCTs:

Randomized controlled trials

SD:

Standard deviation

TUMT:

Transurethral microwave therapy

TUNA:

Transurethral needle ablation

TURP:

Transurethral resection of the prostate

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Acknowledgments

The authors are very grateful to the Urology Department of Beijing Tongren Hospital for their selfless help in this work.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81772698 to Hao Ping) and the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beijing Tongren Hospital, Beihang University & Capital Medical University (Grant No. BHTR-KFJJ-202005 to Hao Ping).

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Correspondence to Hao Ping.

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The scientific guarantor of this publication is Professor Hao Ping.

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The authors declare that they have no competing interests.

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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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Xiang, P., Guan, D., Du, Z. et al. Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Eur Radiol 31, 4929–4946 (2021). https://doi.org/10.1007/s00330-020-07663-2

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