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Prostatic Artery Embolization versus Standard Surgical Treatment for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review and Meta-analysis

  • Valentin Zumstein 1,
  • Patrick Betschart 2,
  • Malte W. Vetterlein 3,
  • Luis A. Kluth 4,
  • Lukas Hechelhammer 5,
  • Livio Mordasini 6,
  • Daniel S. Engeler 2,
  • Thomas M. Kessler 7,
  • Hans-Peter Schmid 2,
  • Dominik Abt 2
1 Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 2 Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland 3 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany 4 Department of Urology, University Medical Center Frankfurt, Frankfurt (Main), Germany 5 Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland 6 Department of Urology, Lucerne Cantonal Hospital, Lucerne, Switzerland 7 Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland

Publication: European Urology Focus, September 2018

Prostatic artery embolization (PAE) has been introduced into clinical practice for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS) despite a lack of high-level evidence.

To perform a systematic review and meta-analysis of clinical trials comparing efficacy and safety of PAE versus established surgical therapies.

Evidence acquisition:
Medline, Embase, and York CRD were searched up to June 23, 2018. Only comparative studies were included. The risk of bias was assessed by the Cochrane Collaboration tool. Meta-analyses were performed using RevMan 5.3.

Evidence Synthesis:
Five studies including 708 patients met the selection criteria. Risk of bias was rated high for most of the studies. Mean reduction in the International Prostate Symptom Score was lower after PAE compared with standard surgical therapies (mean difference 3.80 points [95% confidence interval: 2.77-4.83]; p<0.001). PAE was less efficient regarding improvements in all functional parameters assessed including maximum urinary flow, post void residual, and reduction of prostate volume. In contrast, patient-reported erectile function (International Index of Erectile Function 5) was better after PAE and significantly fewer adverse events occurred after PAE.

Moderately strong evidence confirms efficacy and safety of PAE in the treatment of BPH-LUTS in the short term. Significant advantages regarding safety and sexual function, but clear disadvantages regarding all other patient-reported and functional outcomes were found for PAE. Large-scale randomized controlled trials including longer follow-up periods are mandatory before PAE can be considered as a standard therapy and to define the ideal indication for PAE in the management of BPH-LUTS.

Patient Summary:
We reviewed the role of prostatic artery embolization (PAE) in the treatment of symptoms associated with benign overgrowth of the prostate. The results suggest that PAE is not as effective as established surgical therapies but has fewer side effects. Further research is required to determine whether PAE is the best treatment for certain types of patients. PAE should, therefore, not yet be considered a standard treatment.