International Urology and Nephrology

, Volume 49, Issue 2, pp 197–203 | Cite as

Prostatic artery embolization in treating benign prostatic hyperplasia: a systematic review

  • Jeremy Y. C. TeohEmail author
  • Peter K. F. Chiu
  • Chi-Hang Yee
  • Hon-Ming Wong
  • Chi-Kwok Chan
  • Eddie S. Y. Chan
  • Simon S. M. Hou
  • Chi-Fai Ng
Urology - Original Paper



We systemically reviewed the current evidence on prostatic artery embolization (PAE) in treating men with benign prostatic hyperplasia.


A systemic literature search was conducted in PubMed, EMBASE and Web of Science on 1 May 2016 without time constraints. Outcomes of interest included the changes in the International Prostate Symptom Score (IPSS), quality-of-life (QOL) score, peak urinary flow (Qmax), post-void residual urine (PVR), International Index of Erectile Function (IIEF) score, prostate volume (PV) and prostate-specific antigen (PSA) level.


A total of 987 records were identified through database searching. After removing duplicates, screening and reviewing full-length texts, a total of five records remained, with two randomized controlled trials and three non-randomized cohort studies. Transurethral resection of prostate resulted in better IPSS than PAE. Open prostatectomy had better IPSS, QOL score, Qmax and PVR, but worse IIEF score than PAE at 1 year. Unilateral PAE had higher rate of poor clinical outcome than bilateral PAE, but the difference became statistically insignificant after adjusting for age; IPSS, QOL score, Qmax, PVR, IIEF score, PV and PSA did not differ between the two groups. PAE with 100 μm PVA particles resulted in greater reduction in PSA level, but worse IIEF score than PAE with 200 μm PVA particles; IPSS, QOL score, Qmax, PVR, PV and poor clinical outcome did not differ between the two groups.


Evidence on different aspects of PAE was limited. Further studies are warranted to investigate the role of PAE as compared to other forms of medical and surgical treatment.


Embolisation Embolization Prostate Prostatic disease 


Author contributions

JYT, PKC and CFN carried out the study. JYT, CHY and HMW participated in the study design. JYT and PKC collected the data. JYT coordinated the study. JYT, PKC and CFN drafted the manuscript. CKC, ESC, SSH and CFN supervised the study.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Berry SJ, Coffey DS, Walsh PC, Ewing LL (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479PubMedGoogle Scholar
  2. 2.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP)-incidence, management, and prevention. Eur Urol 50:969–979 (discussion 80) CrossRefPubMedGoogle Scholar
  3. 3.
    DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS (2000) Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 11:767–770CrossRefPubMedGoogle Scholar
  4. 4.
    Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M et al (2014) Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled clinical trial. Radiology 270:920–928CrossRefPubMedGoogle Scholar
  5. 5.
    Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M (2016) 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 39:44–52CrossRefPubMedGoogle Scholar
  6. 6.
    Russo GI, Kurbatov D, Sansalone S, Lepetukhin A, Dubsky S, Sitkin I et al (2015) Prostatic arterial embolization vs open prostatectomy: a 1-year matched-pair analysis of functional outcomes and morbidities. Urology 86:343–348CrossRefPubMedGoogle Scholar
  7. 7.
    Bilhim T, Pisco J, Rio Tinto H, Fernandes L, Campos Pinheiro L, Duarte M et al (2013) Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 36:403–411CrossRefPubMedGoogle Scholar
  8. 8.
    Bilhim T, Pisco J, Campos Pinheiro L, Rio Tinto H, Fernandes L, Pereira JA et al (2013) Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 24(1595–602):e1Google Scholar
  9. 9.
    Garraway WM, Collins GN, Lee RJ (1991) High prevalence of benign prostatic hypertrophy in the community. Lancet 338:469–471CrossRefPubMedGoogle Scholar
  10. 10.
    Brown CT, Yap T, Cromwell DA, Rixon L, Steed L, Mulligan K et al (2007) Self management for men with lower urinary tract symptoms: randomised controlled trial. BMJ 334:25CrossRefPubMedGoogle Scholar
  11. 11.
    Djavan B, Marberger M (1999) A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Eur Urol 36:1–13CrossRefPubMedGoogle Scholar
  12. 12.
    McConnell JD, Roehrborn CG, Bautista OM, Andriole GL Jr, Dixon CM, Kusek JW et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398CrossRefPubMedGoogle Scholar
  13. 13.
    Roehrborn CG, Siami P, Barkin J, Damiao R, Major-Walker K, Nandy I et al (2010) The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4-year results from the CombAT study. Eur Urol 57:123–131CrossRefPubMedGoogle Scholar
  14. 14.
    Neal DE (1997) The national prostatectomy audit. Br J Urol 79(Suppl 2):69–75CrossRefPubMedGoogle Scholar
  15. 15.
    Mebust WK, Holtgrewe HL, Cockett AT, Peters PC (1989) Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol 141:243–247PubMedGoogle Scholar
  16. 16.
    Serretta V, Morgia G, Fondacaro L, Curto G, Lo Bianco A, Pirritano D et al (1990) Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology 2002(60):623–627Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Jeremy Y. C. Teoh
    • 1
    • 2
    Email author
  • Peter K. F. Chiu
    • 1
  • Chi-Hang Yee
    • 1
  • Hon-Ming Wong
    • 1
  • Chi-Kwok Chan
    • 1
  • Eddie S. Y. Chan
    • 1
    • 2
  • Simon S. M. Hou
    • 1
  • Chi-Fai Ng
    • 1
    • 2
  1. 1.Division of Urology, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong KongShatinChina
  2. 2.S.H. Ho Urology Centre, Division of Urology, Department of Surgery, 4/F LCW Clinical Science BuildingPrince of Wales Hospital, The Chinese University of Hong KongShatinChina

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