Prostate Artery Embolization Versus Transurethral Resection Of Prostate For Benign Prostatic Hyperplasia Treatment: Meta Analysis

Objective:We aimed to compare the efficacy and safety between prostate artery embolization(PAE)and transurethral resection of prostate(TURP)for the treatment of benign prostatic hyperplasia(BPH),and to offer the theory basis for the selection of appropriate treatment options for benign prostatic hyperplasia.Methods:Datebases such as PubMed,EMBASE,Cochrane Library,CNKI,CBM,VIP and WanFangData were used to search the randomized controlled trials(RCTs)and non-RCTs about PAE vs TURP research for the benign prostatic hyperplasia treatment.After the study selection,assessment and data extraction were conducted by two researches independently,and meta-analysis was conducted using the Rev Man 5.3 software to compare the efficacy and safety between PAE and TURP for the treatment of BPH.Results:Nine studies including 675 patients which met with the selection criteria were involved in our study.The meta-analysis result showed that: 1.The.clinical efficacy of PAE was equal to TURP after 3 months follow-up,and the curative effect of PAE group was better than that of TURP group.The optimization of IPSS,QoL,Qmax,PVR and PV of the PAE group was also significantly better than the TURP group.After 12 months follow-up,though there was no statistically significant difference in the improvement of IPSS and PVR,some of indicators such as QoL,Qmax and PV of the PAE group was significantly well than that of the TURP group.Thus,the improvement of TURP group was better than that of the PAE group.At last,we found there was no statistically significant difference in the improvement of IPSS,QoL,Qmax,PVR and PV between the PAE group and TURP group after 24 months follow-up;while the failure rate was higher in the PAE group(4.4%)than that of the TURP group(0.5%).2.Safety indicator: The results indicated that PAE group had less blood loss [MD=-98.25,95%CI(-105.51,-91.00),P < 0.00001],shorter catheterization time [MD=-1.61,95%CI(-2.31,-0.90),P < 0.0006],and shorter hospital stay [MD=-3.07,95%CI(-4.40,-1.74),P < 0.00001] compared with TURP group,though there was no significant difference in operation time between the two groups [MD=17.28,95% CI(-15.92,50.48),P=0.31];The complications in the PAE group(21.6%)were significanatly lower than that in the TURP group(33.7%).Conclusion:The short-term efficacy(3 months)of the PAE in the treatment of BPH is less effect than the TURP,and its failure rate is higher than TURP,but the medium and long-term efficacy(24 months)of the PAE is equal to the TURP group.PAE is superior to TURP in intraoperative blood loss,time of indwelling catheter,time of hospital stay and the proportion complications.There is no enough evidence to conclude that PAE is superior than TURP for the treatment of BPH.More investigations with large-scale persons and rational designed research are needed to explore a optional therapeutic method for the BPH treatment.PAE can be used for patients with BPH who cannot tolerate anesthesia and TURP.