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

Jung, Jae Hung; McCutcheon, Karen; Borofsky, Michael S.; Young, Shamar; Golzarian, Jafar; Reddy, Balaji; Shin, Tae Young; Kim, Myung Ha; Dahm, Philipp

doi:10.1002/14651858.cd012867.pub2

Cited by 24 publications

(29 citation statements)

References 95 publications

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“…Importantly, PAE may reduce postprocedural ejaculatory dysfunction, although few data on erectile dysfunction are available [ 7 , 29 ]. After longer follow-ups, QoL appears similar with TURP and PAE, but the need for reintervention may be higher with PAE [ 30 ]. PAE might be a valuable alternative for the treatment of BPH-related LUTSs in selected patients in whom the symptoms are the main reason for considering surgery [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Loffroy¹,

Guillen²,

Salet

et al. 2021

JCM

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Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 ± 7.4 years; range, 54–85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 ± 0.3 mL, total injection time was 21.9 ± 7.8 s, and total radiation dose was 18,458 ± 16,397 mGy·cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 ± 6.8 versus 20.5 ± 6.7, p = 0.0001), quality-of-life score (2.2 ± 1.5 versus 4.9 ± 1.0, p = 0.0001), prostate-specific antigen level (4.6 ± 3.0 versus 6.4 ± 3.7, p = 0.0001), and prostate volume (77.3 ± 30.5 versus 98.3 ± 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted.

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Section: Discussionmentioning

confidence: 99%

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Loffroy¹,

Guillen²,

Salet

et al. 2021

JCM

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“…We updated the methods of this review based on the protocol of a suite of reviews on minimally invasive treatments for LUTS [ 7 8 9 ]. We included parallel-group RCTs regardless of their publication status or language.…”

Section: Methodsmentioning

confidence: 99%

“…Some alternatives to TURP include laser enucleation, vaporisation, and Aquablation, but they all require spinal anaesthesia [ 2 ]. In recent years, the number of men undergoing TURP has steadily declined due to increasing pharmacologic treatments (alpha-blockers and 5-alpha-reductase inhibitors) and minimally-invasive treatments that are usually performed under local anaesthesia [ 6 ], such as convective radiofrequency water vapour therapy [ 7 ], prostatic urethral lift [ 8 ], prostatic arterial embolisation [ 9 ] which are covered in current evidence-based guidelines [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia: An Updated Cochrane Review

Franco

Garegnani

Liquitay

et al. 2022

World J Mens Health

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Purpose To assess the effects of transurethral microwave thermotherapy (TUMT) for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH). Materials and Methods We performed a comprehensive search using multiple databases up to May 2021, with no language or publication status restrictions. We included parallel-group randomized controlled trials of participants with BPH who underwent TUMT. We used standard Cochrane methods, including a GRADE assessment of the certainty of the evidence (CoE). Results In this update of a previous Cochrane review, we included 16 trials with 1,919 participants. TUMT probably results in little to no difference in urologic symptom scores at short-term follow-up compared to transurethral resection of the prostate (TURP). There is likely to be little to no difference in the quality of life. TUMT likely results in fewer major adverse events. TUMT, however, probably results in a large increase in the need for retreatment. There may be little to no difference in erectile function between these interventions. However, TUMT may result in fewer cases of ejaculatory dysfunction compared to TURP. The overall CoE was moderate to low. Conclusions TUMT provides a similar reduction in urinary symptoms compared to TURP, with fewer major adverse events and fewer cases of ejaculatory dysfunction at short-term follow-up. However, TUMT probably results in a large increase in retreatment rates. Study limitations and imprecision reduced the confidence we can place in these results.

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“…A 2019 meta-analysis compared PAE and TURP by assessing four studies, all of which had a follow-up time period of at least 12 months. 2 This study therefore also used a 12-month time horizon where the outcomes of PAE and TURP were observed at 12 months post intervention. This is in line with the original UK-ROPE Study which also aimed to assess outcomes at 12 months.…”

Section: Methodsmentioning

confidence: 99%

“…There have been multiple studies that have demonstrated the clinical effectiveness of PAE versus transurethral resection of the prostate (TURP), with significant improvements in symptoms, as measured by the International Prostatic Symptom Score (IPSS) reduction. 2 3 However, there are limited data on the cost utility of TURP compared with PAE.…”

Section: Introductionmentioning

confidence: 99%

1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH)

Patel

Yung

Vigneswaran

et al. 2021

BMJ Surg Interv Health Technologies

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ObjectiveTo determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up.Design, setting and main outcome measuresA retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions.ResultsThe mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up.ConclusionOur findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years.Trial registration numberNCT02434575.

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

Cited by 24 publications

References 95 publications

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Transurethral Microwave Thermotherapy for Benign Prostatic Hyperplasia: An Updated Cochrane Review

1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH)

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