Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia.

Abstract

To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE. Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21ml/s to +9.5ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10% of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.