Department of Urology, Beijing Tongren Hospital, Capital Medical University, No1. Dongjiaomingxiang street, Dongcheng District, Beijing, 100730, China.
Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University & Capital Medical University, Beijing Tongren Hospital, Beijing, 100730, China.
Eur Radiol. 2021 Jul;31(7):4929-4946. doi: 10.1007/s00330-020-07663-2. Epub 2021 Jan 15.
To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points.
PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model.
Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (- 0.44 to 5.09)) and quality of life (0.18 (- 0.41 to 0.77)) at 12 months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24 months.
PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24 months without causing serious complications.
• PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times. • PAE is inferior to TURP in the improvement of most functional outcomes. • Improvements due to PAE are durable during follow-up to 24 months.
研究前列腺动脉栓塞术（PAE）与经尿道前列腺切除术（TURP）治疗前列腺增生（BPH）的疗效和安全性。我们还回顾了 PAE 在选定随访点的基线平均变化。
检索 PubMed、Web of Science 和 Embase，检索截至 2020 年 5 月 1 日。根据具体的纳入和排除标准收集 PAE 的随机对照试验。使用 RevMan 5.3、STATA 14 和 GraphPad Prism 8 进行荟萃分析。使用固定或随机效应模型计算汇总的患者报告评分和功能结果。
11 篇文章符合我们的选择标准，最终分析纳入了 10 项独立的患者系列研究。汇总估计表明，TURP 和 PAE 之间在患者报告的结果方面没有显著差异，包括国际前列腺症状评分（2.32（-0.44 至 5.09））和生活质量（0.18（-0.41 至 0.77））在 12 个月时。PAE 在改善大多数功能结果方面效果较差，如最大流量、前列腺体积和前列腺特异性抗原。此外，PAE 可能与相对较少的并发症、较低的成本和较短的住院时间相关。在 PAE 手术后，除性功能评分外，所有结果的总体加权平均差异在随访期间从基线显著改善，持续到 24 个月。
PAE 在改善患者报告的结果方面与 TURP 相当，但大多数功能参数在 TURP 后比在 PAE 后变化更大。此外，PAE 可以在 24 个月内显著缓解症状，而不会引起严重并发症。
• PAE 在改善主观症状评分方面与 TURP 一样有效，且并发症较少，住院时间较短。• PAE 在改善大多数功能结果方面不如 TURP。• PAE 的改善在随访 24 个月期间是持久的。
