Russo Giorgio Ivan, Kurbatov Dmitry, Sansalone Salvatore, Lepetukhin Alexander, Dubsky Sergey, Sitkin Ivan, Salamone Costanza, Fiorino Livio, Rozhivanov Roman, Cimino Sebastiano, Morgia Giuseppe
Department of Urology, University of Catania, Catania, Italy.
Andrological and Urological Department, Endocrinological Research Centre, Moscow, Russia.
Urology. 2015 Aug;86(2):343-8. doi: 10.1016/j.urology.2015.04.037. Epub 2015 Jul 18.
To evaluate 1-year surgical and functional results and morbidities of prostatic artery embolization (PAE) vs open prostatectomy (OP).
We undertook 1:1 matched-pair analysis (International Prostate Symptom Score [IPSS], peak flow [PF], postvoid residual [PVR], and prostate volume) of 287 consecutive patients treated for benign prostatic obstruction, including 80 OP and 80 PAE. Inclusion criteria were as follows: lower urinary tract symptoms or benign prostatic obstruction, IPSS ≥12, prostate-specific antigen (PSA) <4 ng/mL, or PSA between 4 and 10 ng/mL but negative prostate biopsy, total prostate volume >80 cm(3), and PF <15 mL/s. Follow-up was performed at 1 month, 6 months, and 1 year at clinic. Primary end points of the study were the comparison regarding IPSS, International Index of Erectile Function-5, PF, PVR, and IPSS quality of life (IPSS-QoL) after 1 year of follow-up.
Regarding primary end points, OP group had lower IPSS (4.31 vs 10.40; P <.05), 1-year PVR (6.15 vs 18.38; P <.05), 1-year PSA (1.33 vs 2.12; P <.05), IPSS-QoL (0.73 vs 2.78; P <.05), International Index of Erectile Function-5 (10.88 vs 15.13; P <.05), and greater PF (23.82 vs 16.89; P <.01). The matched-pair comparison showed higher value of postoperative hemoglobin level (mg/dL) and shorter hospitalization (days) and catheterization (days) for PAE group. At the multivariate logistic regression, PAE was associated with persistent symptoms (IPSS ≥8; odds ratio, 2.67; 95% confidence interval [CI], 0.96-7.4; P <.01) and persistent PF ≤15 mL/s (odds ratio, 4.95; 95% confidence interval, 1.73-14.15; P <.05) after 1 year.
PAE could be considered a feasible minimally invasive technique but failed to demonstrate superiority to OP because of the increased risk of persistent symptoms and low PF after 1 year.
评估前列腺动脉栓塞术（PAE）与开放性前列腺切除术（OP）的1年手术及功能结果和并发症情况。
我们对287例因良性前列腺梗阻接受治疗的连续患者进行了1:1配对分析（国际前列腺症状评分[IPSS]、峰值尿流率[PF]、残余尿量[PVR]和前列腺体积），其中包括80例行OP手术的患者和80例行PAE手术的患者。纳入标准如下：下尿路症状或良性前列腺梗阻、IPSS≥12、前列腺特异性抗原（PSA）<4 ng/mL，或PSA在4至10 ng/mL之间但前列腺活检阴性、前列腺总体积>80 cm³，以及PF<15 mL/s。在门诊进行1个月、6个月和1年的随访。该研究的主要终点是随访1年后在IPSS、国际勃起功能指数-5、PF、PVR和IPSS生活质量（IPSS-QoL）方面的比较。
关于主要终点，OP组的IPSS较低（4.31对10.40；P<.05）、1年PVR较低（6.₁5对18.38；P<.05）、1年PSA较低（1.33对2.12；P<.05）、IPSS-QoL较低（0.73对2.78；P<.05）、国际勃起功能指数-5较低（10.88对15.13；P<.05），且PF较高（23.82对16.89；P<.01）。配对比较显示PAE组术后血红蛋白水平（mg/dL）较高，住院时间（天）和导尿时间（天）较短。在多因素逻辑回归分析中，PAE与1年后持续症状（IPSS≥8；比值比，2.67；95%置信区间[CI]，0.96 - 7.4；P<.01）和持续PF≤15 mL/s（比值比，4.95；95%置信区间，1.73 - 14.15；P<.05）相关。
PAE可被视为一种可行的微创技术，但由于1年后持续症状风险增加和PF较低，未能证明其优于OP。
