Skip to main content

Advertisement

Log in

An updated meta-analysis of prostatic arterial embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Objective

To investigate whether prostatic arterial embolization (PAE) could be recommended as a routine therapy for benign prostatic hyperplasia (BPH), we conducted an updated meta-analysis to assess the efficacy and safety of PAE compared with transurethral resection of the prostate (TURP).

Methods

Systematic literature retrieval by searching data from Web of science, Pubmed, Embase, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP databases was carried out to identify all related trials from the inception dates to June 2019. We also conducted subgroup analyses depending on the kind of study design, kind of PAE and kind of TURP.

Results

Nine studies comparing PAE with TURP involving a total of 860 BPH patients were selected. Postoperative reduced IPSS score (MD 2.50; 95% CI 0.78–4.21; P = 0.004), postoperative reduced QOL score (MD 0.40; 95% CI 0.09–0.71; P = 0.01), postoperative reduced PV (MD 8.59; 95% CI 4.74–12.44; P < 0.00001) and postoperative increased Qmax (MD 2.54; 95% CI 1.02–4.05; P = 0.001) were better in TURP than in PAE; however, PAE was associated with lower sexual dysfunction rate (OR 0.24; 95% CI 0.15–0.39; P < 0.00001) compared with TURP. Meanwhile, no significant difference in postoperative reduced PVR (MD 0.46; 95% CI − 2.08 to 3.00; P = 0.72) and complication (OR 0.57; 95% CI 0.21–1.55; P = 0.27) between PAE and TURP group was demonstrated.

Conclusion

PAE was inferior to TURP in the improvement of postoperative IPSS, QOL, PV, Qmax and TURP still remained the gold standard. However, PAE may be a valuable alternative to TURP in the treatment of BPH patients who refuse surgery or with surgery contraindication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Oelke M, Bachmann A, Descazeaud A et al (2013) EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol 64(1):118–140. https://doi.org/10.1016/j.eururo.2013.03.004

    Article  PubMed  Google Scholar 

  2. Thorpe A, Neal D (2003) Benign prostatic hyperplasia. Lancet 361(9366):1359–1367. https://doi.org/10.1016/S0140-6736(03)13073-5

    Article  CAS  PubMed  Google Scholar 

  3. McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803. https://doi.org/10.1016/j.juro.2011.01.074

    Article  PubMed  Google Scholar 

  4. Foster HE, Barry MJ, Philipp D et al (2018) Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline. J Urol 200(3):612–619. https://doi.org/10.1016/j.juro.2018.05.048

    Article  PubMed  Google Scholar 

  5. Shim SR, Kanhai K, Ko YM et al (2017) Efficacy and safety of prostatic arterial embolization: systematic review with meta-analysis and meta-regression. J Urol 197(2):465–479. https://doi.org/10.1016/j.juro.2016.08.100

    Article  PubMed  Google Scholar 

  6. Jiang YL, Qian LJ (2019) Transurethral resection of the prostate versus prostatic artery embolization in the treatment of benign prostatic hyperplasia: a meta-analysis. BMC Urol 19(1):11. https://doi.org/10.1186/s12894-019-0440-1

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zumstein V, Betschart P, Vetterlein MW et al (2018) Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Urol Focus S2405–4569(18):30277–30283. https://doi.org/10.1016/j.euf.2018.09.005

    Article  Google Scholar 

  8. Carnevale FC, Iscaife A, Yoshinaga EM et al (2016) Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective. Urodynamic-controlled analysis. Cardiovasc Intervent Radiol 39(1):44–52. https://doi.org/10.1007/s00270-015-1202-4

    Article  PubMed  Google Scholar 

  9. Gao Y, Huang Y, Zhang R et al (2014) Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 270(3):920–928. https://doi.org/10.1148/radiol.13122803

    Article  PubMed  Google Scholar 

  10. Ray AF, Powell J, Speakman MJ et al (2018) The UK ROPE Study: efficacy and safety of prostate artery embolisation for benign prostatic hyperplasia. An observational study and propensity matched comparison with transurethral resection of the prostate. BJU Int 122:270–282. https://doi.org/10.1111/bju.14249

    Article  PubMed  Google Scholar 

  11. Qiu ZL, Wang Q, Cheng K et al (2016) The evaluation of super-selective prostatic arterial embolization in the treatment of benign prostatic hyperplasia. Chin J Urol 37(10):758–761. https://doi.org/10.3760/cma.j.issn.1000-6702.2016.10.009

    Article  Google Scholar 

  12. Abt D, Lukas H, Gautier M et al (2018) Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 361:k2338. https://doi.org/10.1136/bmj.k2338

    Article  PubMed  PubMed Central  Google Scholar 

  13. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4

    Article  CAS  PubMed  Google Scholar 

  14. Banares R, Albillos A, Rincon D et al (2002) Endoscopic treatment versus endoscopic plus pharmacologic treatment for acute variceal bleeding: a meta-analysis. Hepatology 35(3):609–615. https://doi.org/10.1053/jhep.2002.31354

    Article  PubMed  Google Scholar 

  15. Zhang M, Chen C, Wang X et al (2017) Levofloxacin-based triple therapy versus bismuth-based quadruple therapy in the treatment of Heficobacter pylori as the rescue therapy: a meta analysis. Chin J Intern Med 56(5):368–374. https://doi.org/10.3760/cma.j.issn.0578-1426.2017.05.013

    Article  CAS  Google Scholar 

  16. Wells GA, Shea BJ, O’Connell D et al (2011) The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. https://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed 5 Nov 2019

  17. Qi X, Jia J, Bai M et al (2015) Transjugular intrahepatic portosystemic shunt for acute variceal bleeding: a meta-analysis. J Clin Gastroenterol 49(6):495–505. https://doi.org/10.1097/MCG.0000000000000205

    Article  PubMed  Google Scholar 

  18. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748. https://doi.org/10.1093/jnci/22.4.719

    Article  CAS  PubMed  Google Scholar 

  19. Dersimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188. https://doi.org/10.1016/0197-2456(86)90046-2

    Article  CAS  PubMed  Google Scholar 

  20. Yang Z, Han G, Wu Q et al (2010) Patency and clinical outcomes of transjugular intrahepatic portosystemic shunt with polytetrafluoroethylene-covered stents versus bare stents: a meta-analysis. J Gastroenterol Hepatol 25(11):1718–1725. https://doi.org/10.1111/j.1440-1746.2010.06400.x

    Article  PubMed  Google Scholar 

  21. Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  22. Poulou LS, Thanos L, Ziakas PD (2010) Unifying the predictive value of pretransplant FDG PET in patients with lymphoma: a review and meta-analysis of published trials. Eur J Nucl Med Mol Imaging 37(1):156–162. https://doi.org/10.1007/s00259-009-1258-y

    Article  PubMed  Google Scholar 

  23. Chevalier TL, Scagliotti G, Natale R et al (2005) Efficacy of gemcitabine plus platinum chemotherapy compared with other platinum containing regimens in advanced non-small-cell lung cancer: a meta-analysis of survival outcomes. Lung Cancer 47(1):69–80. https://doi.org/10.1016/j.lungcan.2004.10.014

    Article  PubMed  Google Scholar 

  24. Egger M, Davey Smith G, Schneider M et al (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634. https://doi.org/10.1136/bmj.315.7109.629

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Deng J, Han GY, Xu WG et al (2013) Clinical evaluation of arterial embolization the treatment of benign prostatic hyperplasia. J Mod Urol 18(1):60–62

    Google Scholar 

  26. Hou HY, Yang BZ (2016) Comparison of short-term and long-term effects of prostatic arterial embolization, transurethral resection of prostate and conservative treatment in treatment of benign prostatic hyperplasia. Med and Pharm J Chin PLA 28(2):91–95. https://doi.org/10.3969/j.issn.2095-140X.2016.12.024

    Article  Google Scholar 

  27. Tan XY (2018) Comparison of efficacy of prostatic arterial embolization and transurethral resection in treatment of benign prostatic hyperplasia. Chin J Mod Drug Appl 12(14):56–57. https://doi.org/10.14164/j.cnki.cn11-5581/r.2018.14.029

    Article  Google Scholar 

  28. Zhu CH, Lin WJM, Huang ZY et al (2018) Prostate artery embolization and transurethral resection of prostate for benign prostatic hyperplasia: A prospective randomized controlled trial. Chin J Interv Imaging Ther 15(3):134–138. https://doi.org/10.13929/j.1672-8475.201711043

    Article  Google Scholar 

  29. Sun F, Sánchez FM, Crisóstomo V et al (2011) Transarterial prostatic embolization: initial experience in a canine model. Am J Roentgenol 197(2):495–501. https://doi.org/10.2214/AJR.10.5947

    Article  Google Scholar 

  30. Poulakis V, Nikolaos F et al (2006) Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl 8(1):69–74. https://doi.org/10.1111/j.1745-7262.2006.00088.x

    Article  PubMed  Google Scholar 

  31. Bilhim T, Bagla S, Sapoval M et al (2015) Prostatic arterial embolization versus transurethral resection of the prostate for benign prostatic hyperplasia. Radiology 276(1):310–311. https://doi.org/10.1148/radiol.2015141853

    Article  PubMed  Google Scholar 

  32. Kwon JS, Lee JW, Lee SW et al (2011) Comparison of effectiveness of monopolar and bipolar transurethral resection of the prostate and open prostatectomy in large benign prostatic hyperplasia. Korean J Urol 52(4):269–273. https://doi.org/10.4111/kju.2011.52.4.269

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gu RZ, Xia SJ (2011) Surgical options for benign prostatic hyperplasia: impact on sexual function and risk factors. Zhonghua Nan Ke Xue 17(9):837–841. https://doi.org/10.3724/SP.J.1077.2011.00049

    Article  CAS  PubMed  Google Scholar 

  34. Chen YB, Chen Q, Wang Z et al (2013) A prospective, randomized clinical trial comparing plasmakinetic resection of the prostate with holmium laser enucleation of the prostate based on a 2-year follow up. J Urol 189(1):217–222. https://doi.org/10.1016/j.juro.2012.08.087

    Article  PubMed  Google Scholar 

  35. Ronzoni G, De Vecchis M (1998) Preservation of anterograde ejaculation after transurethral resection of both the prostate and bladder neck. Br J Urol 81(6):830–833. https://doi.org/10.1046/j.1464-410x.1998.00658.x

    Article  CAS  PubMed  Google Scholar 

  36. Metz P (1986) Arteriogenic erectile impotence. Dan med bull 33(3):134–150

    CAS  PubMed  Google Scholar 

  37. Wang MQ, Duan F, Yuan K et al (2017) Benign prostatic hyperplasia: cone-beam CT in conjunction with DSA for identifying prostatic arterial anatomy. Radiology 282(1):271–280. https://doi.org/10.1148/radiol.2016152415

    Article  PubMed  Google Scholar 

  38. Bilhim T, Pisco JM, Furtado A et al (2011) Prostatic arterial supply: demonstration by multirow detector Angio CT and catheter angiography. Eur Radiol 21(5):1119–1126. https://doi.org/10.1007/s00330-010-2015-0

    Article  PubMed  Google Scholar 

  39. Bilhim T, Pisco JM, Tinto HR et al (2012) Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 23(11):1403–1415. https://doi.org/10.1016/j.jvir.2012.07.028

    Article  PubMed  Google Scholar 

  40. Burnett AL, Nehra A, Breau RH et al (2018) Erectile dysfunction: AUA guideline. J Urol 200(3):633–641. https://doi.org/10.1016/j.juro.2018.05.004

    Article  PubMed  Google Scholar 

  41. Muntener M, Aellig S, Kuettel R et al (2007) Sexual function after transurethral resection of the prostate (TURP): results of an independent prospective multicentre assessment of outcome. Eur Urol 52(2):510–515. https://doi.org/10.1016/j.eururo.2007.01.088

    Article  PubMed  Google Scholar 

  42. Li Z, Chen P, Guo Y et al (2016) The impact of surgical treatments for lower urinary tract symptoms/benign prostatic hyperplasia on male erectile function: a systematic review and network meta-analysis. Medicine 95(24):e3862. https://doi.org/10.1097/MD.0000000000003862

    Article  PubMed  PubMed Central  Google Scholar 

  43. Pisco JM, Pinheiro LC, Bilhim T et al (2011) Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 22(1):11–19. https://doi.org/10.1016/j.jvir.2010.09.030

    Article  PubMed  Google Scholar 

  44. Wang MQ, Guo LP, Zhang GD et al (2015) 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 15:33. https://doi.org/10.1186/s12894-015-0026-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Wang M, Guo L, Duan F et al (2015) Prostatic arterial embolization for the treatment of lower urinary tract symptoms as a result of large benign prostatic hyperplasia: a prospective single-center investigation. Int J Urol 22(8):766–772. https://doi.org/10.1111/iju.12797

    Article  PubMed  Google Scholar 

  46. Li Q, Duan F, Wang MQ et al (2015) 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 128(15):2072–2077. https://doi.org/10.4103/0366-6999.161370

    Article  PubMed  PubMed Central  Google Scholar 

  47. Amouyal G, Thiounn N, Pellerin O et al (2016) Clinical results after prostatic artery embolization using the PErFecTED technique: a single-center study. Cardiovasc Interv Radiol 39(3):367–375. https://doi.org/10.1007/s00270-015-1267-0

    Article  Google Scholar 

  48. Lin YT, Amouyal G, Correas JM et al (2016) Can prostatic arterial embolisation (PAE) reduce the volume of the peripheral zone? MRI evaluation of zonal anatomy and infarction after PAE. Eur Radiol 26(10):3466–3473. https://doi.org/10.1007/s00330-015-4177-2

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

XX: project development and data collection. JL: data collection and analysis. XH: manuscript writing. QL: manuscript writing.

Corresponding authors

Correspondence to Xiang zhong Huang or Qiang Liu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent is waived, because this study is a review article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 593 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xu, X.j., Li, J., Huang, X.z. et al. An updated meta-analysis of prostatic arterial embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia. World J Urol 38, 2455–2468 (2020). https://doi.org/10.1007/s00345-019-03044-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-019-03044-7

Keywords

Navigation