Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia

• Published in: Cochrane database of systematic reviews 2020-12, Vol.12 (12), p.CD012867
• Main Authors: Jung, Jae Hung, McCutcheon, Karen Ann, Borofsky, Michael, Young, Shamar, Golzarian, Jafar, Reddy, Balaji, Shin, Tae Young, Kim, Myung Ha, Narayan, Vikram, Dahm, Philipp
• Format: Article
• Language: English
• Subjects: Aged; Arteries; Benign Prostatic Hyperplasia/Obstruction (Hypertrophy, Prostatic Hyperplasia); Ejaculation; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Humans; Insurance medicine; Lower Urinary Tract Symptoms - therapy; Male; Penile Erection; Postoperative Complications - etiology; Prostate - blood supply; Prostatic Hyperplasia - complications; Quality of Life; Randomized Controlled Trials as Topic; Retreatment - statistics & numerical data; Sexual Dysfunction, Physiological - etiology; Transurethral Resection of Prostate - adverse effects; Treatment Outcome; Urology
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD012867.pub2

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. We performed a comprehensive search using multiple databases (The Cochrane Library, MEDLINE, Embase, LILACS, Scopus, Web of Science, and Google Scholar), trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up until 25 September 2020. We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 with LUTS attributed to BPH undergoing PAE versus TURP or other surgical interventions.  DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidance to rate the certainty of evidence of RCTs and NRSs.  MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT). Mean age, IPSS, and prostate volume of participants were 66 years, 22.8, and 72.8 mL, respectively. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. PAE versus TURP We included six RCTs and two NRSs with short-term (up to 12 months) follow-up and one RCT with long-term follow-up (13 to 24 months).  Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.55, 95% confidence interval [CI] -0.40 to 3.50; 369 participants; 6 RCTs; I² = 75%; low-certainty evidence) measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms. There may be little to no difference in quality of life (MD 0.16, 95% CI -0.37 to 0.68; 309 participants; 5 RCTs; I² = 56%; low-certainty evidence) as measured by the IPSS quality of life