Long-term Efficacy of Prostatic Artery Embolization Alone Versus Prostatic Artery Embolization Followed by HoLEP for Large (> 80 cm) Benign Prostatic Hyperplasia.

RATIONALE AND OBJECTIVES

To compare the long-term efficacy of prostatic artery embolization (PAE) with PAE followed by holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) in patients with large prostatic volume (PV>80 cm), and to identify the appropriate population for PAE+HoLEP.

METHODS

From March 2015 to December 2023, 208 consecutive BPH patients were enrolled into two groups: PAE monotherapy (Group A, n=168) and PAE followed by HoLEP (Group B, n=40). Differences in clinical and functional parameters between baseline and each follow-up point were compared. Cumulative clinical success rates were assessed. Predictors of lower urinary tract symptoms (LUTS) recurrence were analyzed using ROC analyses and Cox proportional hazards regression.

RESULTS

The median follow-up times in Group A and B were 36 and 48 months. Both groups showed significant improvements in clinical and functional parameters at each follow-up period compared to baseline (P<0.01). Cumulative clinical success rates in Group A were 95.3%, 91.6%, 80.6%, 68.0%, and 47.9%, compared to 100%, 100%, 100%, 100%, and 85.7% in Group B at 1, 2, 3, 4, and 5 years. Unilateral PAE and PV≥150.3 cm were independent predictors of LUTS recurrence in Group A (P<0.001).

CONCLUSION

PAE monotherapy and combination PAE+HoLEP were effective options for patients with large PV, but the LUTS recurrence rate of PAE increased over time. Unilateral PAE was a significant factor for recurrence. Patients with PV≥150.3 cm could be good candidates for a combined approach.