Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial

Abstract

Purpose: To compare prostatic arterial embolization (PAE) and transurethral resection of the prostate (TURP) in the care of patients with benign prostatic hyperplasia (BPH).

Materials and methods: This prospective randomized clinical trial was approved by the institutional review board. A total of 114 patients provided written informed consent and were randomly assigned to undergo PAE (n = 57) or TURP (n = 57). The groups were compared regarding relevant adverse events and complications. Functional results--including improvement of International Prostate Symptom Score (IPSS), quality of life (QOL), peak urinary flow, postvoiding residual urine volume, prostate-specific antigen (PSA) level, and prostate volume--were assessed at 1-, 3-, 6-, 12-, and 24-month follow-up between January 20, 2007, and January 31, 2012. Student t test, χ(2) test, Fisher exact test, and repeated measures analysis of variance were used, as appropriate.

Results: Overall technical success rates for TURP and PAE were 100% and 94.7%, respectively; the clinical failure rates were 3.9% and 9.4%, respectively. The six functional results showed improvements after TURP and PAE at all follow-up time points when compared with preoperative values (P = .001). However, the TURP group showed greater degrees of improvement in the IPSS, QOL, peak urinary flow, and postvoiding residual urine volume at 1 and 3 months, as well as greater reductions in the PSA level and prostate volume at all follow-up time points, when compared with the PAE group (P < .05). The PAE group showed more overall adverse events and complications (P = .029), mostly related to acute urinary retention (25.9%), postembolization syndrome (11.1%), and treatment failures (5.3% technical; 9.4% clinical).

Conclusion: Both procedures resulted in significant clinical improvements in the treatment of BPH. However, the advantages of the PAE procedure must be weighed against the potential for technical and clinical failures in a minority of patients.