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Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis

  • B. Malling
  • M. A. Røder
  • K. Brasso
  • J. Forman
  • M. Taudorf
  • L. Lönn
Urogenital
  • 223 Downloads

Abstract

Objectives

Prostate artery embolisation (PAE) is a new minimally invasive treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). The purpose of this study was to review the efficacy and safety of PAE in the treatment of BPH with LUTS.

Methods

A systematic review performed according to the PRISMA guidelines with a pre-specified search strategy for PubMed, Web of Science, Cochrane Library and Embase databases protocol (PROSPERO ID: CRD42017059196). Trials studying the efficacy of prostate artery embolisation to treat LUTS with more than ten participants and follow-up longer than 6 months were included by two independent authors. Outcomes investigated were International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR) and complications. To summarise mean change from baseline, a meta-analysis was done using the random-effects model.

Results

The search returned 210 references, of which 13 studies met the inclusion criteria, representing 1,254 patients. Patients in the included studies with data available for meta-analysis had moderate to severe LUTS and a mean IPSS of 23.5. Statistically significant (p value < 0.05) improvements of all investigated outcomes were seen at 12-month follow-up. Major complications were reported in 0.3% of the cases.

Conclusions

Our findings suggest that PAE can reduce moderate to severe LUTS in men with BPH with a low risk of complications.

Key Points

• Prostate artery embolisation (PAE) improved International Prostate Symptom Score (IPSS) by 67%.

• Major complications after PAE are very rare.

• Use of cone-beam CT may reduce risk of non-target embolisation.

Keywords

Male Lower urinary tract symptoms Prostatic hyperplasia Embolisation, therapeutic 

Abbreviations

AUR

Acute urinary retention

BPH

Benign prostatic hyperplasia

IPSS

International Prostate Symptom Score

IIEF-5

International Index of Erectile Function

LUTS

Lower urinary tract symptoms

NTE

Non-target embolisation

PAE

Prostate artery embolisation

PES

Post-embolisation syndrome

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-analysis

PSA

Prostate-specific antigen

PV

Prostate volume

PVR

Post-void residual

Qmax

Peak urinary flow

QoL

Quality of life

SIR

Society of Interventional Radiology

TURP

Transurethral resection of the prostate

UTI

Urinary tract infection

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Professor Lars Lönn.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Lars Lönn, Medical Director, Mentice.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this was a systematic review and meta-analysis.

Ethical approval

Institutional Review Board approval was not required because this was a systematic review and meta-analysis.

Methodology

• prospective

• systematic review and meta-analysis

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • B. Malling
    • 1
  • M. A. Røder
    • 2
  • K. Brasso
    • 2
  • J. Forman
    • 3
  • M. Taudorf
    • 1
  • L. Lönn
    • 1
  1. 1.Department of Diagnostic RadiologyRigshospitaletCopenhagenDenmark
  2. 2.Department of UrologyRigshospitaletCopenhagenDenmark
  3. 3.Department of Public HealthUniversity of CopenhagenCopenhagenDenmark

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