Abstract
Purpose
To summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia.
Methods and Materials
A database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included.
Results
The search yielded 193 articles, of which ten studies representing 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months.
Conclusion
This suggests that PAE is effective in treating LUTS in the short and intermediate term.
References
Lepor H. Pathophysiology of lower urinary tract symptoms in the aging male population. Rev Urol. 2005;7(Suppl 7):S3.
Berry SJ, Coffey DS, Walsh PC, Ewing LL. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132(3):474–9.
Raheem OA, Parsons JK. Associations of obesity, physical activity, and diet with benign prostatic hyperplasia and lower urinary tract symptoms. Curr Opin Urol. 2014;24(1):10–4.
Mobley D, Feibus A, Baum N. Benign prostatic hyperplasia and urinary symptoms: evaluation and treatment. Postgrad Med. 2015;127(3):301–7.
Bechis SK, Otsetov AG, Ge R, Olumi AF. Personalized medicine for management of benign prostatic hyperplasia. J Urol. 2014;192(1):16–23.
Hollingsworth JM, Wilt TJ. Lower urinary tract symptoms in men. BMJ. 2014;349:g4474.
Marszalek M, Ponholzer A, Pusman M, Berger I, Madersbacher S. Transurethral resection of the prostate. Eur Urol Suppl. 2009;8:504–12.
Mayer EK, Kroeze SGC, Chopra S, Bottle A, Patel A. Examining the ‘gold standard’: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int. 2012;110:1595–601.
Mitchell ME, Waltman AC, Athanasoulis CA, Kerr WS, Dretler SP. Control of massive prostatic bleeding with angiographic techniques. J Urol. 1976;115:692–5.
DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol. 2000;11(6):767–70.
Camara-Lopes G, Mattedi R, Antunes AA, et al. The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. Int Braz J Urol. 2013;39:222–7.
Bagla S, Martin CP, van Breda A, et al. Early results from a united states trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol. 2014;25(1):47–52.
Bilhim T, Pisco J, Campos Pinheiro L, Rio Tinto H, Fernandes L, Pereira JA, et al. Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? J Vasc Interv Radiol. 2013;24(11):1595–602.
Bilhim T, Pisco J, Rio Tinto H, Fernandes L, et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Interv Radiol. 2013;36(2):403–11.
Carnevale FC, da Motta-Leal-Filho JM, Antunes AA, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24(4):535–42.
de Assis AM, Moreira AM, de Paula Rodrigues VC, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates >90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26(1):87–93.
Gao YA, Huang Y, Zhang R, Yang YD, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled clinical trial. Radiology. 2014;270(3):920–8.
Kurbatov D, Russo GI, Lepetukhin A, et al. Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study. Urology. 2014;84(2):400–4.
Li Q, Duan F, Wang M-Q, Zhang G-D, Yuan K. Prostatic arterial embolization with small sized particles for the treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia: preliminary results. Chin Med J. 2015;128(15):2072–7.
Pisco JM, Rio Tinto H, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira AG. Embolization of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23(9):2561–72.
Wang MQ, Guo LP, Zhang GD, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population. BMC Urol. 2015;15:33.
OCEBM Levels of Evidence Working Group. The Oxford levels of evidence 2. Oxford Centre for Evidence-Based Medicine; 2011.
Fujimura T, Kume H, Nishimatsu H, Sugihara T, Nomiya A, Tsurumaki Y, Miyazaki H, Suzuki M, Fukuhara H, Enomoto Y, Homma Y. Assessment of lower urinary tract symptoms in men by international prostate symptom score and core lower urinary tract symptom score. BJU Int. 2012;109(1):1512–6.
Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology. 1997;49(6):822–30.
Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratzke C, McVary K, Novara G, Woo H, Madersbacher S. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066–96.
Taher A. Erectile dysfunction after transurethral resection of the prostate: incidence and risk factors. J Urol. 2004;22(6):457–60.
Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur Urol. 2006;50:969–79.
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There are no conflicts of interest or financial disclosures to declare for M. Kuang, A. Vu, or S. Athreya.
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Michelle Kuang and Anthony Vu contributed equally to this manuscript. Dr. Athreya proof-read the manuscript.
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Kuang, M., Vu, A. & Athreya, S. A Systematic Review of Prostatic Artery Embolization in the Treatment of Symptomatic Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 40, 655–663 (2017). https://doi.org/10.1007/s00270-016-1539-3
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DOI: https://doi.org/10.1007/s00270-016-1539-3