Prostatic Arterial Embolization Treating Moderate-to-Severe Lower Urinary Tract Symptoms Related to Benign Prostate Hyperplasia: A Meta-Analysis

Abstract

Purpose: To evaluate the clinical efficiency and safety of PAE treating moderate-to-severe LUTS related to BPH.

Materials and methods: A systematic literature search was performed using PUBMED, EMBASE, Cochrane database of systematic review, and Web of Science, up to April 2016, to identify eligible studies. The Cochrane Collaboration's RevMan 5.3 was used to analyze the extracted data. Random- or fixed-effect model was selected to fit the pooled out heterogeneity.

Results: 20 eligible studies were included in this meta-analysis. Synthetic data showed that there were statistically significant improvements in IPSS (MD = -13.25; 95% CI -14.81 to -11.69; P < 0.00001), QoL score (MD = -2.34; 95% CI -2.69 to -2.00, P < 0.00001), PSA level (MD = -1.33; 95% CI -1.86 to -0.80; P < 0.00001), PV (MD = -28.00; 95% CI -35.94 to -20.07; P < 0.00001), Qmax (MD = 5.51; 95% CI 4.62 to 6.40; P < 0.00001), and PVR (MD = -67.8; 95% CI -81.35 to -53.60; P < 0.00001). There was no significant difference in IIEF score (MD = 0.93; 95% CI 0.43-1.42; P = 0.07). Major complications following PAE include pain in the perineum, retropubic area, and/or urethra (9.4%), and hematuria (9.0%).

Conclusions: PAE should be considered to be the very promising alternative treatment for those who do not want or cannot tolerate surgical treatment, with its benefits on IPSS, QoL score, PSA level, PV, Qmax, and PVR without affecting erectile function.

Keywords: Benign prostate hyperplasia; Lower urinary tract symptoms; Prostatic arterial embolization; Treatment.