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Lebdai S, Delongchamps NB, Sapoval M, Robert G, Amouyal G, Thiounn N, Karsenty G, Ruffion A, de La Taille A, Descazeaud A, Mathieu R. World J Urol 2016; 34(5): 625–632
Prostatic arterial embolization for benign prostatic hyperplasia
Benign prostatic obstruction (BPO) is a major cause of lower urinary tract symptoms (LUTS) with implications for public health.1 The European Association of Urology recommends transurethral resection of the prostate (TURP) and open prostatectomy as standard surgical procedures for treatment of BPO. Recently, prostatic arterial embolization (PAE) has been proposed as an alternative.1
PAE was first reported as a treatment for BPO in clinical practice in 2008, although specific indications for PAE treatment remain to be defined.1 In a recent systematic review of primary research Lebdai et al evaluated the early results of PAE treatment of BPO in patients with LUTS and the role of PAE as a treatment strategy for BPO.1
A total of 57 research articles published between January 2008 and January 2015 were identified.1 After exclusion of articles with cohorts of <30 patients or with overlaps in data collection, four articles were included in this review, three cohort studies and one randomised control study investigating PAE compared to TURP.1
Functional outcomes
In all studies, PAE led to improvements in International Prostate Symptom Score (IPSS), and increases in mean urine peak flow volume were shown at 3 months after treatment in comparison to baseline.1
Three months after treatment:
- Improvements in mean IPSS ranged from 7.2–15.6 points
- Improvements in mean urine peak-flow ranged from 3.2–9.5 mL/s.1
PAE versus TURP
In the one clinical trial that assessed PAE in comparison to TURP, a significantly lower IPSS reduction was found 1 and 3 months after the PAE procedure compared to TURP.1
From 6–12 months after treatment, a trend towards similar symptom improvement was reported for PAE and TURP.1
Morbidity and complications
Mild adverse events including transient hyperthermia, rectal bleeding and urinary tract problems (such as haematuria, pain when urinating and acute urinary retention) were reported in 10% of patients after PAE.1 However, a significantly higher rate of urine retention was reported 30 days after PAE in comparison to TURP (25.9% and 5.7%, respectively, p=0.004) in the randomised controlled study.1 Transient urinary catheter was used to treat urinary retention and no treatment was required for other adverse events.1
Only two major complications associated with PAE were reported in the studies reviewed: one case of urinary sepsis that required intravenous antibiotics and one case of partial necrosis of the bladder, resulting from imprecise embolisation, that required surgery.1
Conclusions
The authors concluded that although early results were promising, this was not sufficient to recommend PAE for the effective treatment of BPO in patients with LUTS due to a lack of data on feasibility, safety and mid-term efficiency and further clinical studies by multidisciplinary teams were required.1
Report on: Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia. Lebdai S, Delongchamps NB, Sapoval M, Robert G, Amouyal G, Thiounn N, Karsenty G, Ruffion A, de La Taille A, Descazeaud A, Mathieu R. World J Urol 2016; 34(5): 625–632.
