Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and metaanalysis

BACKGROUND Prostate artery embolization(PAE)is a promising minimally invasive therapy that improves lower urinary tract symptoms(LUTS)related to benign prostatic hyperplasia(BPH).Transurethral resection of the prostate(TURP)is the gold standard therapy for LUTS/BPH.AIM To evaluate the efficacy and safety of PAE vs TURP on LUTS related to BPH.METHODS A literature review was performed to identify all published articles on PAE vs TURP for LUTS/BPH.Sources included PubMed,Embase,Cochrane library databases,and Chinese databases before June 2022.A systematic review and meta-analysis were conducted.Outcome measurements were combined by calculating the mean difference with a 95%confidence interval.Statistical analysis was carried out using Review Manager 5.3.RESULTS Eleven studies involving 1070 participants were included.Compared with the TURP group,the PAE group had a similar effect on the International Index of Erectile Function(IPSS)score,Peak urinary flow rate(Qmax),postvoid residual volume(PVR),Prostate volume(PV),prostatic specific antigen(PSA),The International Index of Erectile Function short form(IIEF-5)scores,and erectile dysfunction during 24 mo follow-up.Lower quality of life(QoL)score,lower rate of retrograde ejaculation and shorter hospital stay in the PAE group.There was no participant death in either group.A higher proportion of haematuria,urinary incontinence and urinary stricture was identified in the TURP group.CONCLUSION PAE may be an appropriate option for elderly patients,patients who are not candidates for surgery,and patients who do not want to risk the potential adverse effects of TURP.Studies with large cases and long follow-up time are needed to validate results.

Top 50 most cited articles on prostatic artery embolization for benign prostatic hyperplasia:A bibliometric review

BACKGROUND Bibliometric analysis can be used to assess the current state of the literature and publication trends on a given topic.There has not been a review of this kind on prostatic artery embolization(PAE)for benign prostatic hyperplasia(BPH).PAE is a relatively new and somewhat controversial treatment option for BPH.Given the novelty and controversy,there has been much research published on the topic recently.AIM To survey the current state of research on PAE for BPH by using bibliometric analysis to analyze the top 50 most highly cited articles.METHODS A cross-sectional study was performed using the Web of Science database to identify the most cited articles published on PAE for BPH as of June 2022.Articles that did not primarily focus on PAE or BPH as an indication were eliminated.The 50 most cited articles were carried forward for analysis.RESULTS All but 6 articles were published in the last decade with contributions from 15 countries.Fifty-two percent of the studies had a C level of evidence.The majority were published in the Journal of Vascular and Interventional Radiology and Cardiovascular and Interventional Radiology.Twenty percent(n=10)of the articles were published in urologic journals.On average,articles published in urologic journals tended to be more recent.The mean year of publication for an article in a urological journal was 2016.6 compared to 2013.9 in a non-urologic journal(P=0.02).Seventy percent of the articles focused on clinical outcomes,while only 2%focused on practice guidelines.Self-citations accounted for 11.4 citations perarticle on average,corresponding to 14.7%of all citations analyzed.CONCLUSION The most influential papers on this topic represent a fairly recent body of work with contributions from a wide variety of countries and journals.The fact that articles in urologic journals were published significantly more recently than articles on the list in non-urologic journals may suggest that the field of urology is starting to accept PAE for a wider range of indications.Finally,while there has been much high-quality research published,more influential studies on practice guidelines and technique may be beneficial.

Prostatic artery embolization: Progress and prospect

Prostate artery embolization is a well-known and promising treatment for benign prostatic hyperplasia, with the quantum leaps of research in medicine. We aim to provide an up-to-date review of the novel technique, including large retrospective studies and randomized control trials, ends with discussions of advantages and disadvantages of this minimally invasive technique.

Sonographic evaluation of prostatic artery embolization:Far beyond size measurements

Prostatic artery embolization(PAE)has gained acceptance as a minimally invasive,safe and effective treatment of symptomatic benign prostatic hyperplasia.Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes.In this context,ultrasonography(US)has a central and multifaceted role.Gray-scale US is routinely utilized for measurement of significant outcome parameters(prostatic volume,intra-vesical prostatic protrusion and post-void residual volume)before and after PAE.Improvement of these parameters may become more obvious onemonth post-PAE,or later.Contrast-enhanced US(CEUS)with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts(as enhancement defects)immediately post-PAE and monitor their resolution over time.The volume of prostatic infarcts can also be measured and compared to prostatic volume.Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and(at least in some patients)of clinical success.CEUS can also be performed intraoperatively in the angio-suite,for on-site evaluation of the ischemic effect;a variation of this technique,with intraarterial(instead of intravenous)administration of diluted echo enhancer,can also be applied intraoperatively,to map the embolized territory and to prevent non-target embolization.Initial experience with USelastographic techniques(shear-wave and strain elastography)has shown that they can detect and quantify the improvement of tissue elasticity post-PAE,thus providing new insights into the therapeutic mechanisms of this treatment.With utilization of high-end equipment,experience and standardized imaging protocols,US could be the primary modality for imaging evaluation of PAE.

Minimally invasive surgical therapies(MISTs)for lower urinary tract symptoms(LUTS):promise or panacea?

The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs).Recently,the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia(BPH)to the management of nonneurogenic male LUTS.The aim of the present review was to evaluate the efficacy and safety of the most commonly used MisTs:ablative techniques such as aquablation,prostatic artery embolization,water vapor energy,and transperineal prostate laser ablation,and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device(iTIND).MiSTs are becoming a new promise,even if clinical trials with longer follow-up are still lacking.Most of them are still under investigation and,to date,only a few options have been given as a recommendation for use.They cannot be considered as standard of care and are not suitable for all patients.Advantages and disadvantages should be underlined,without forgetting our objective:treatment of LUTS and re-treatment avoidance.

Prostatic Arterial Embolization with Small Sized Particles for the Treatment of Lower Urinary Tract Symptoms Due to Large Benign Prostatic Hyperplasia： Preliminary Results

Background：The clinical failure after prostatic artery embolization （PAE） with conventional particles was relatively high,in treatment for lower urinary tract symptoms （LUTS） due to benign prostatic hyperplasia （BPH）.We reported the results of PAE with combined polyvinyl alcohol particles 50 μm and 100 μm in size as a primary treatment in 24 patients with severe LUTS secondary to large BPH.Methods：From July 2012 to June 2014,we performed PAE in 24 patients （65-85 years,mean 74.5 years） with severe LUTS due to large BPH （≥80 cm^3） and refractory to medical therapy.Embolization was performed using combination of 50 μm and 100 μm in particles size.Clinical follow-up was performed using the International Prostate Symptom Score （IPSS）,quality of life （QoL）,peak urinary floW （Qmax）,postvoid residual （PVR） volume,the International Index of Erectile Function （IIEF）,prostatic specific antigen （PSA）,and prostatic volume measured by magnetic resonance imaging at 1,3,6,and every 6-month thereafter.Technical success was defined when PAE was completed in at least one pelvic side.Clinical success was defined as the improvement of both symptoms and QoL.A Student＇s t-test for paired samples was used.Results：PAE was technically successful in 22 patients （92%）.Bilateral PAE was performed in 19 （86%） patients and unilateral in 3 （14%） patients.Follow-up data were available for 22 patients observed for mean of 14 months.The clinical improvement at 1,3,6,and 12-month was 91%,91%,88%,and 83%,respectively.At 6-month follow-up,the mean IPSS,QoL,PVR,and Qmax were from 27 to 8 （P =0.001）,from 4.5 to 2.0 （P =0.002）,from 140.0 ml to 55.0 ml （P =0.002）,and from 6.0 ml/s to 13.0 ml/s （P =0.001）,respectively.The mean prostate volume decreased from 110 cm3 to 67.0 cm3 （mean reduction of 39.1%;P =0.00 1）.The PSA and IIEF improvements after PAE did not differ from pre-PAE significantly.No major adverse events were noted.Conclusions：The combination of 50μm and 100 μm particles for PAE is a safe and effective treatment method for patients with severe LUTS due to large BPH,which further improves the clinical results of PAE.