Jung Jae Hung, McCutcheon Karen Ann, Borofsky Michael, Young Shamar, Golzarian Jafar, Kim Myung Ha, Narayan Vikram, Dahm Philipp
Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea.
Center of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea.
BJU Int. 2023 Jan;131(1):32-45. doi: 10.1111/bju.15823. Epub 2022 Jul 13.
To assess the effects of prostatic arterial embolisation (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).
We included randomised controlled trials (RCTs), as well as non-randomised studies (NRSs) enrolling men with BPH undergoing PAE vs other surgical interventions via a comprehensive search up until 8 November 2021. Two independent reviewers screened the literature, extracted data, assessed risk of bias, performed statistical analyses by using a random-effects model, and rated the certainty of evidence (CoE) of RCTs and NRSs.
We found data to inform two comparisons: PAE vs transurethral resection of prostate (TURP; six RCTs and two NRSs), and PAE vs sham (one RCT). This abstract focuses on the primary outcomes in a comparison of PAE vs TURP. Short-term follow-up: based on RCT evidence, there may be little to no difference in urological symptom score improvement (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; low CoE) and quality of life (QoL; MD 0.28, 95% CI -0.28 to 0.84; low CoE) measured by International Prostatic Symptom Score. We are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19-2.97; very low CoE). Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urological symptom scores (MD 2.58, 95% CI -1.54 to 6.71; low CoE) and QoL (MD 0.50, 95% CI -0.03 to 1.04; low CoE). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20-4.05; very low CoE).
Compared to TURP, the impact on urological symptoms and QoL improvement as perceived by patients appears to be similar. This review did reveal major uncertainty as to how major adverse events compare.
评估与其他治疗方法相比，前列腺动脉栓塞术（PAE）对良性前列腺增生（BPH）男性下尿路症状（LUTS）的治疗效果。
我们纳入了随机对照试验（RCT）以及非随机研究（NRS），这些研究纳入了接受PAE与其他手术干预的BPH男性患者，通过全面检索至2021年11月8日。两名独立的审阅者筛选文献、提取数据、评估偏倚风险，使用随机效应模型进行统计分析，并对RCT和NRS的证据确定性（CoE）进行评级。
我们发现有数据可用于两项比较：PAE与经尿道前列腺切除术（TURP；六项RCT和两项NRS），以及PAE与假手术（一项RCT）。本摘要重点关注PAE与TURP比较中的主要结局。短期随访：基于RCT证据，在国际前列腺症状评分所测量的泌尿系统症状评分改善方面（平均差[MD]1.72，95%置信区间[CI]-0.37至3.81；低CoE）以及生活质量（QoL；MD 0.28，95%CI-0.28至0.84；低CoE）方面，可能几乎没有差异。我们对PAE对主要不良事件的影响非常不确定（风险比[RR]0.75，95%CI 0.19 - 2.97；极低CoE）。长期随访：基于RCT证据，PAE在泌尿系统症状评分（MD 2.58，95%CI -1.54至6.71；低CoE）和QoL（MD 0.50，95%CI -0.03至1.04；低CoE）方面可能几乎没有差异。我们对主要不良事件非常不确定（RR 0.91，95%CI 0.20 - 4.05；极低CoE）。
与TURP相比，患者所感知的对泌尿系统症状和QoL改善的影响似乎相似。本综述确实揭示了在主要不良事件比较方面存在重大不确定性。
