Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of
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REVIEW
EMBOLISATION (ARTERIAL)
Systematic Review and Meta-analysis Comparing Prostatic Artery Embolization to Gold-Standard Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia Gabriel M. Knight1 • Abhinav Talwar1 • Riad Salem1,2
•
Samdeep Mouli1,2
Received: 4 January 2020 / Accepted: 18 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) for the management of benign prostatic hyperplasia (BPH). Materials and Methods A multi-database search for relevant literature was conducted on 15 July 2020 to include studies published on or before that date. Search terms used were: (prostate embolization OR prostatic embolization OR prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction). Risk of bias was assessed using Cochrane Collaboration and ROBINS-I criteria. Random-effects meta-analysis was performed using RevMan 5.3. Results Six studies with 598 patients were included. TURP was associated with significantly more improvement in maximum urinary flow rate (Qmax) (mean difference = 5.02 mL/s; 95% CI [2.66,7.38]; p \ 0.0001; I2 = 89%), prostate volume (mean difference = 15.59 mL; 95% CI [7.93,23.25]; p \ 0.00001; I2 = 88%), and prostate-specific antigen (PSA) (mean difference = 1.02 ng/ mL; 95% CI [0.14,1.89]; p = 0.02; I2 = 71%) compared to
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00270-020-02657-5) contains supplementary material, which is available to authorized users. & Riad Salem [email protected] 1
Department of Radiology, Section of Interventional Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611, USA
2
Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago, IL, USA
PAE. No significant difference between PAE and TURP was observed for changes in International Prostate Symptoms Score (IPSS), IPSS quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), and postvoid residual (PVR). PAE was associated with fewer adverse events (AEs) (39.0% vs. 77.7%; p \ 0.00001) and shorter hospitalization times (mean difference = -1.94 days; p \ 0.00001), but longer procedural times (mean difference = 51.43 min; p = 0.004). Conclusion Subjective symptom improvement was equivalent between TURP and PAE. While TURP demonstrated larger improvements for some objective parameters, PAE was associated with fewer AEs and shorter hospitalization times. Level of Evidence II Level 2a, Systematic Review
Introduction It is estimated that between 25 and 60% of men will suffer from benign prostatic hyperplasia (BPH) over their lifetime [1–4]. BPH can impair bladder voiding via bladder outlet obstruction (BOO) and often causes uncomfortable urinary s
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