An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Abstract

Background: Prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH) has been introduced into clinical practice, but conclusive evidence of efficacy and safety has been lacking.Objective: To compare the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of prostate (TURP), we performed a meta-analysis of clinical trials.Methods: We searched randomized controlled trials (RCTs) from Pubmed, Embase, Wanfang, and CNKI from January 2000 to December 2020 and used RevMan 5.0 to analyze the data after five RCTs were included.Results: The reducing of prostate volume (PV) [Median mean (MD) 14.87; 95% confidence interval (CI) 7.52–22.22; P < 0.0001] and the increasing of maximum flow rate in free uroflowmetry (Qmax) (MD 3.73; 95% CI 0.19–7.27; P = 0.004) were more obvious in TURP than in PAE; however, the rate of lower sexual dysfunction [odds ratio (OR) 0.12; 95% CI 0.05–0.30; P < 0.00001] was lower in PAE compared with TURP. Meanwhile, no conspicuous difference in International Prostate Symptoms Score (IPSS) score (MD 1.42; 95% CI −0.92 to 3.75; P = 0.23), quality of life (Qol) score (MD 0.21; 95% CI −0.31 to 0.73; P = 0.43), post void residual (PVR) (MD 21.16; 95% CI −5.58 to 47.89; P = 0.12), prostate-specific antigen (PSA) (MD 0.56; 95% CI −0.15 to 1.27; P = 0.12), and complications (OR 0.90; 95% CI 0.20–4.05; P = 0.89) between PAE and TURP group was shown.Conclusion: PAE may replace TURP as an alternative treatment for Benign prostatic hyperplasia (BPH) patients who do not want to have surgery or with operational contraindications.

The State of Evidence in Prostate Artery Embolization

“…In a systematic review and meta-analysis exclusively of randomized controlled trials, Xu et al demonstrated that while prostate volume and Qmax improvement were greater following TURP, there were no significant differences in terms of IPSS, QoL, and PVR between PAE and TURP. 28 The complication rate was also comparable between PAE and TURP, but the former resulted in a lower rate of sexual dysfunction. Similarly, a recently published Cochrane review suggests that PAE may provide similar improvement in urological symptoms and QoL compared to TURP, but PAE is associated with less ejaculatory disorders.…”

One‐year outcomes after prostate artery embolization versus laser enucleation: A network meta‐analysis

“…One metaanalysis found no statistically significant difference in the adverse effects between PAE and TURP [OR 0.90; 95%CI: 0.20-4.05]. 41 The evidence for adverse events between HoLEP and TURP has been…”

“…The IPSS score improvement can be used to quantify the success or failure of BPH treatment 40 . Prior literature has been variable regarding the efficacy of PAE, TURP and HoLEP on IPSS score outcomes, with some studies reporting non‐inferiority between the PAE‐TURP and HoLEP‐TURP 1,9,33,41 . A recent meta‐analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: −0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41 .…”

“…Prior literature has been variable regarding the efficacy of PAE, TURP and HoLEP on IPSS score outcomes, with some studies reporting non‐inferiority between the PAE‐TURP and HoLEP‐TURP 1,9,33,41 . A recent meta‐analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: −0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41 . Another meta‐analysis showed an IPSS effect size of MD 2.50 (95%CI: 0.78 to 4.21) in favour of TURP [inferiority of one of the treatments compared] 1 .…”

“…1,9,33,41 A recent meta-analysis reported that the effect size on IPSS score was MD 1.42 (95%CI: À0.92 to 3.75) when PAE and TURP were compared at 12 months [no statistically significant difference between treatments compared] 41. Another meta-analysis showed an IPSS effect size of MD 2.50 (95%CI: 0.78 to 4.21) in favour of TURP [inferiority of one of the treatments compared] 1.…”