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Published in: CardioVascular and Interventional Radiology 5/2014

01-10-2014 | Clinical Investigation

The Role of Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia: A Systematic Review

Authors: S. M. Schreuder, A. E. Scholtens, J. A. Reekers, S. Bipat

Published in: CardioVascular and Interventional Radiology | Issue 5/2014

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Abstract

Purpose

This study was designed to summarize the evidence on clinical outcomes and complications of prostatic arterial embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Methods

We searched Medline and Embase for PAE trials of patients with BPH upto November 2013. Two reviewers independently checked the inclusion and exclusion criteria and performed data extraction of study characteristics, quantitative and qualitative outcomes, and complications.

Results

The search yielded 562 studies, of which 9 articles with 706 patients were included. In these 9 articles, there was a possible overlap of data and the quality of 8 studies was assessed as poor. All patients had moderate-to-severe, lower urinary tract symptoms (LUTS). The mean age ranged from 63.4–74.1 years. After embolization, a decrease of the prostate volume (PV) and post void residual (PVR) was seen mainly in the first month with a further decrease up to 12 months, increasing afterwards. The prostate specific antigen (PSA) decreased up to 3 months after PAE, increasing afterwards. The peak urinary flow (Qmax) increased mainly the first month and decreased after 30 months. The international prostate symptom score (IPSS) and quality of life-related symptoms (QOL) improved mainly during the first month, with a further improvement up to 30 months. No deterioration of the international index of erectile function (IIEF) was seen after PAE. The PAE procedure seems safe.

Conclusions

Although the number of studies was small, qualitatively poor, and with overlap of patients, the initial clinical outcomes as reported up to 12 months seem positive and the procedure seems safe.
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Literature
1.
go back to reference McVary KT (2006) BPH: epidemiology and comorbidities. Am J Manag Care 12(5 Suppl):S122–S128PubMed McVary KT (2006) BPH: epidemiology and comorbidities. Am J Manag Care 12(5 Suppl):S122–S128PubMed
2.
go back to reference Rosen RC, Giuliano F, Carson CC (2005) Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 47(6):824–837PubMedCrossRef Rosen RC, Giuliano F, Carson CC (2005) Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 47(6):824–837PubMedCrossRef
3.
go back to reference Wei JT, Calhoun E, Jacobsen SJ (2005) Urologic diseases in America project: benign prostatic hyperplasia. J Urol 173(4):1256–1261PubMedCrossRef Wei JT, Calhoun E, Jacobsen SJ (2005) Urologic diseases in America project: benign prostatic hyperplasia. J Urol 173(4):1256–1261PubMedCrossRef
4.
go back to reference Barry MJ, Fowler FJ Jr, O’Leary MP et al (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148(5):1549–1557PubMed Barry MJ, Fowler FJ Jr, O’Leary MP et al (1992) The American Urological Association symptom index for benign prostatic hyperplasia. The Measurement Committee of the American Urological Association. J Urol 148(5):1549–1557PubMed
5.
go back to reference O’Leary MP (2000) LUTS, ED, QOL: alphabet soup or real concerns to aging men? Urology 56(5 Suppl):7–11PubMedCrossRef O’Leary MP (2000) LUTS, ED, QOL: alphabet soup or real concerns to aging men? Urology 56(5 Suppl):7–11PubMedCrossRef
6.
go back to reference American Urological Association Guideline: management of benign prostatic hyperplasia (BPH) (2010) American Urological Association Guideline: management of benign prostatic hyperplasia (BPH) (2010)
7.
go back to reference Michel MC, Mehlburger L, Bressel HU et al (1998) Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol 160(3 Pt 1):784–791PubMed Michel MC, Mehlburger L, Bressel HU et al (1998) Tamsulosin treatment of 19,365 patients with lower urinary tract symptoms: does co-morbidity alter tolerability? J Urol 160(3 Pt 1):784–791PubMed
8.
go back to reference McConnell JD, Bruskewitz R, Walsh P et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 338(9):557–563PubMedCrossRef McConnell JD, Bruskewitz R, Walsh P et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 338(9):557–563PubMedCrossRef
9.
go back to reference Rassweiler J, Teber D, Kuntz R et al (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management and prevention. Eur Urol 50(5):969–979PubMedCrossRef Rassweiler J, Teber D, Kuntz R et al (2006) Complications of transurethral resection of the prostate (TURP)—incidence, management and prevention. Eur Urol 50(5):969–979PubMedCrossRef
10.
go back to reference Sun F, Sánchez FM, Crisóstomo V et al (2008) Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment—preliminary study in pigs. Radiology 246(3):783–789PubMedCrossRef Sun F, Sánchez FM, Crisóstomo V et al (2008) Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment—preliminary study in pigs. Radiology 246(3):783–789PubMedCrossRef
11.
go back to reference Jeon GS, Won JH, Lee BM et al (2009) The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study. J Vasc Interv Radiol 20(3):384–390PubMedCrossRef Jeon GS, Won JH, Lee BM et al (2009) The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study. J Vasc Interv Radiol 20(3):384–390PubMedCrossRef
12.
13.
go back to reference Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536PubMedCrossRef Whiting PF, Rutjes AW, Westwood ME et al (2011) QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155(8):529–536PubMedCrossRef
14.
go back to reference Pisco JM, Pinheiro LC, Bilhim T et al (2011) Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 22(1):11–19PubMedCrossRef Pisco JM, Pinheiro LC, Bilhim T et al (2011) Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 22(1):11–19PubMedCrossRef
15.
go back to reference Pisco JM, Rio Tinto H, Campos Pinheiro L et al (2013) Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 23(9):2561–2572PubMedCrossRef Pisco JM, Rio Tinto H, Campos Pinheiro L et al (2013) Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 23(9):2561–2572PubMedCrossRef
16.
go back to reference Pisco J, Campos Pinheiro L, Bilhim T et al (2013) Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology 266(2):668–677PubMedCrossRef Pisco J, Campos Pinheiro L, Bilhim T et al (2013) Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology 266(2):668–677PubMedCrossRef
17.
go back to reference Rio Tinto H, Martins Pisco J, Bilhim T et al (2012) Prostatic artery embolization in the treatment of benign prostatic hyperplasia: short and medium follow-up. Tech Vasc Interv Radiol 15(4):290–293PubMedCrossRef Rio Tinto H, Martins Pisco J, Bilhim T et al (2012) Prostatic artery embolization in the treatment of benign prostatic hyperplasia: short and medium follow-up. Tech Vasc Interv Radiol 15(4):290–293PubMedCrossRef
18.
go back to reference Bilhim T, Pisco J, Campos Pinheiro L et al (2013) Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 24(11):1595–1602PubMedCrossRef Bilhim T, Pisco J, Campos Pinheiro L et al (2013) Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study. J Vasc Interv Radiol 24(11):1595–1602PubMedCrossRef
19.
go back to reference Bilhim T, Pisco J, Rio Tinto H et al (2013) Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 36(2):403–411PubMedCrossRef Bilhim T, Pisco J, Rio Tinto H et al (2013) Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol 36(2):403–411PubMedCrossRef
20.
go back to reference Carnevale FC, da Motta-Leal-Filho JM, Antunes AA et al (2013) Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol 24(4):535–542PubMedCrossRef Carnevale FC, da Motta-Leal-Filho JM, Antunes AA et al (2013) Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol 24(4):535–542PubMedCrossRef
21.
go back to reference Antunes AA, Carnevale FC, da Motta Leal Filho JM et al (2013) Clinical, laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective single-center pilot study. Cardiovasc Intervent Radiol 36(4):978–986PubMedCrossRef Antunes AA, Carnevale FC, da Motta Leal Filho JM et al (2013) Clinical, laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective single-center pilot study. Cardiovasc Intervent Radiol 36(4):978–986PubMedCrossRef
22.
go back to reference Bagla S, Martin CP, van Breda A et al (2014) Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 25(1):47–52 E-publication October 2013PubMedCrossRef Bagla S, Martin CP, van Breda A et al (2014) Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 25(1):47–52 E-publication October 2013PubMedCrossRef
23.
go back to reference Bilhim T, Tinto HR, Fernandes L et al (2012) Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 15(4):276–285PubMedCrossRef Bilhim T, Tinto HR, Fernandes L et al (2012) Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 15(4):276–285PubMedCrossRef
24.
go back to reference Barry MJ (2001) Evaluation of symptoms and quality of life in men with benign prostatic hyperplasia. Urology 58(6 Suppl 1):25–32 discussion 32PubMedCrossRef Barry MJ (2001) Evaluation of symptoms and quality of life in men with benign prostatic hyperplasia. Urology 58(6 Suppl 1):25–32 discussion 32PubMedCrossRef
25.
go back to reference O’Leary MP, Wei JT, Roehrborn CG et al (2008) Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int 101(12):1531–1535PubMedCrossRef O’Leary MP, Wei JT, Roehrborn CG et al (2008) Correlation of the International Prostate Symptom Score bother question with the Benign Prostatic Hyperplasia Impact Index in a clinical practice setting. BJU Int 101(12):1531–1535PubMedCrossRef
26.
go back to reference Rosen RC, Cappelleri JC, Smith MD et al (1999) Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11(6):319–326PubMedCrossRef Rosen RC, Cappelleri JC, Smith MD et al (1999) Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 11(6):319–326PubMedCrossRef
Metadata
Title
The Role of Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia: A Systematic Review
Authors
S. M. Schreuder
A. E. Scholtens
J. A. Reekers
S. Bipat
Publication date
01-10-2014
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 5/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-014-0948-4

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