An Updated Meta-Analysis of the Efficacy and Safety of Prostatic Artery Embolization vs. Transurethral Resection of the Prostate in the Treatment of Benign Prostatic Hyperplasia

Abstract

<b>Background:</b> Prostatic artery embolization (PAE) in the treatment of benign prostatic hyperplasia (BPH) has been introduced into clinical practice, but conclusive evidence of efficacy and safety has been lacking. <b>Objective:</b> To compare the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of prostate (TURP), we performed a meta-analysis of clinical trials. <b>Methods:</b> We searched randomized controlled trials (RCTs) from Pubmed, Embase, Wanfang, and CNKI from January 2000 to December 2020 and used RevMan 5.0 to analyze the data after five RCTs were included. <b>Results:</b> The reducing of prostate volume (PV) [Median mean (MD) 14.87; 95% confidence interval (CI) 7.52-22.22; <i>P</i> < 0.0001] and the increasing of maximum flow rate in free uroflowmetry (Qmax) (MD 3.73; 95% CI 0.19-7.27; <i>P</i> = 0.004) were more obvious in TURP than in PAE; however, the rate of lower sexual dysfunction [odds ratio (OR) 0.12; 95% CI 0.05-0.30; <i>P</i> < 0.00001] was lower in PAE compared with TURP. Meanwhile, no conspicuous difference in International Prostate Symptoms Score (IPSS) score (MD 1.42; 95% CI -0.92 to 3.75; <i>P</i> = 0.23), quality of life (Qol) score (MD 0.21; 95% CI -0.31 to 0.73; <i>P</i> = 0.43), post void residual (PVR) (MD 21.16; 95% CI -5.58 to 47.89; <i>P</i> = 0.12), prostate-specific antigen (PSA) (MD 0.56; 95% CI -0.15 to 1.27; <i>P</i> = 0.12), and complications (OR 0.90; 95% CI 0.20-4.05; <i>P</i> = 0.89) between PAE and TURP group was shown. <b>Conclusion:</b> PAE may replace TURP as an alternative treatment for Benign prostatic hyperplasia (BPH) patients who do not want to have surgery or with operational contraindications.