Urinary Tract Symptoms In Men Research Articles

Predicting the risk of failed trial without catheter following Rezum™ therapy.

Convective water vapor thermal therapy or "Rezum™" treatment for lower urinary tract symptoms in men with benign prostate hypertrophy require postoperative catheterization to avoid acute urinary retention. Unsuccessful catheter removal is still unpredictable. We, therefore, aimed to identify the risk factors of failed initial trial without catheter (TWOC) after Rezum™ therapy inside a large cohort of patients. A retrospective study was conducted on patients who underwent Rezum™ therapy by three referent urologists across two academic hospitals between January 2022 and January 2023. A Foley catheter was systematically placed after therapy for 7days in all patients before TWOC. Patients characteristics [age, imagery, maximum urinary flow rate (Qmax), postvoid residual (PVR)], and treatment outcomes (International Prostate Symptom Score (IPSS), quality of life (QoL), adverse events) were analyzed at baseline and 3months from procedure. Failed initial TWOC was defined as the incapacity to pass urine or measured PVR > 300mL. After univariate selection, the risk factors for TWOC failure were identified using multivariate logistic regression analysis. 216 patients qualified for analysis with 23 (10.6%) failing the first TWOC after 7days of catheterization. After multivariate logistic regression, only preoperative PVR predicted TWOC failure (OR 1.01; p = 0.007). The cut-off of preoperative PVR increasing this risk was 120mL (p = 0, 02). Over 10% of men undergoing Rezum™ therapy for LUTS/BPH will experience TWOC failure and AUR after 7days of catheterization. Preoperative PVR seems to be the only independent risk factor of unsuccessful catheter removal.

The relationship between depression, anxiety and lower urinary tract symptoms in men

PurposePatients with lower urinary tract symptoms (LUTS) often experience comorbid depression and anxiety, yet the mechanisms underlying this association remain incompletely understood. This prospective study aimed to investigate the relationship between depression, anxiety, and LUTS in men. Materials and methodsA prospective study was conducted with 350 male patients who underwent urologic examinations at our institution from January 2021 to December 2021. Of these, 131 patients meeting the inclusion criteria were included. Various questionnaires, including the International Prostate Symptom Score (IPSS) and the Hospital Anxiety and Depression Scale (HADS), as well as LUTS examinations (prostate-specific antigen test, transrectal ultrasonography, and urine flowmetry), were administered. ResultsAmong the 350 patients, 131 were included in the analysis, with an average age of 58.0 ± 13.69 years. The total IPSS was 18.0 ± 8.69, with the average voiding symptom score at 8.7 ± 5.19 and the average storage symptom score at 6.0 ± 3.27. Both anxiety and depression were found to be correlated with LUTS (P < 0.05). After adjusting for age, hypertension, and diabetes, anxiety (but not depression) was significantly associated with LUTS based on regression analysis. ConclusionMen with LUTS are more likely to experience anxiety. Therefore, it is essential to assess and address anxiety when managing men with LUTS.

Uroselective α1A-Adrenoceptor Antagonist Tamsulosin in Treatment Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) is a common condition in older man. Uroselective a1a-adrenoceptor (AR) antagonists tamsulosin and tamsulosin modified release (OCAS) are the most frequently prescribed medications for the men with LUTS due to BPH. Both tamsulosin and tamsulosin OCAS improve the patients disease-specific quality of life, reduce IPSS by approximately 30–40% and increase Qmax by approximately 20– 25%. The high selectivity of tamsulosin to α1А-adrenoceptor and slow release system OCAS provide a minimal vasodilating effect and correspondingly low risks of falls. These benefits are important in the treatment of LUTS in older men.

Effects of L-Carnitine and Coenzyme Q10 Supplementation on Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomized, Controlled, Clinical Trial

The prevalence of benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS) increases with age. Considering that BPH drug treatment is associated with complications, this study aimed to investigate the effects of L-carnitine (LC) and Coenzyme Q10 (CoQ10) supplementation as an adjunct therapy to finasteride in the management of LUTS in older men affected with BPH. Fifty eligible volunteers (25 per group) were randomly assigned to either intervention (finasteride + LC and CoQ10 supplements) or control (finasteride + placebo) groups. International prostate symptom score (IPSS), international index of erectile function (IIEF), quality of life index (QoL), as well as serum levels of Prostate-specific antigen (PSA), were assessed. Prostate ultrasound evaluation was also performed, before and after 8 wk of intervention. Supplementation with LC and CoQ10 led to a significant decrease in prostate volume (p < 0.001) as well as a significant increase in IIEF (p < 0.001), compared to the control group. However, there were no significant between-group differences in IPSS (p = 0.503), QoL scores (p = 0.339), and PSA levels (p = 0.482). CoQ10 and LC supplements might be beneficial in combination with standard therapies in the management of BPH and its related complications.

Treatment of lower urinary tract symptoms in men in primary care using a conservative intervention: cluster randomised controlled trial

ObjectiveTo determine whether a standardised and manualised care intervention in men in primary care could achieve superior improvement of lower urinary tract symptoms (LUTS) compared with usual care.DesignCluster randomised controlled...

Adequate Mentorship Program for Holmium Laser Enucleation of the Prostate (HoLEP) Leads to Satisfactory Short-Term Outcomes in the Early Learning Curve of Young Urologists: First-Year Outcomes of a Newly Established Mentorship Training in Mexico.

Introduction Benign prostatic hyperplasia (BPH) is one of the most common causes of lower urinary tract symptoms in men. Holmium Laser Enucleation of the Prostate (HoLEP) has been recommended by international guidelines as an alternative to transurethral resection of the prostate (TURP). HoLEP's learning curve and the lack of adequate mentorship remains an obstacle for the worldwide adoption of this technique. Objective To report the first-year learning curve of a newly established mentorship program in young urologists without any previous HoLEPexperience. Methods We report a cohort of patients with BPH, with prostate size ≥70 grams, treated with HoLEP, analyzed for perioperative data and complications, and short-term postoperative complications and functional outcomes, at three and six months after surgery. Results A total of 47 patients were managed with HoLEP. Mean total operative time was 149.8 ± 42.9 minutes. We experienced five (10.6%) intraoperative complications, including one intravesical resection of the prostate with bipolar energy, three conversions to TURP and one conversion to open prostatectomy. We experienced four postoperative complications, all of them Clavien-Dindo ≤2. Median International Prostate Symptom Score (IPSS) decrease at six months was -17 points from baseline. Mean post-void residual volume and prostate-specific antigen significantlydecreased by the third postoperative month. Multiple linear regression showed that prostate size is directly related to increased surgical time during the early learning curve. Discussion Our experience adequately reflects the importance of HoLEP mentorship in young urologists seeking training in this technique. Both surgeons had perioperative and postoperative outcomes deemed satisfactory based on previously published learning curves. Conclusions HoLEP is a technically difficult procedure, however, adequate mentorship leads to satisfying short-term outcomes since the early stages of the learning curve in young urologists with no previous training on this technique.

Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial.

The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity.

Australian surgical revision rate for benign prostatic obstruction.

To evaluate the rate of revision surgery following commonly performed procedures for benign prostatic hyperplasia (BPH) is hyperplasia of both glandular and stromal components of prostate especially in periurethral transitional gland, using real-world data from Medicare Australia. Prospection is a Healthcare Data Analytics firm that has negotiated access with the Medicare Benefits Schedule (MBS) to provide longitudinal data on the use of specific procedural item codes. We identified patients over the age of 40 years who had undergone primary transurethral resection of the prostate (TURP), transurethral incision of the prostate (TUIP) or photoselective vaporization of the prostate (PVP) between 2005 and 2010 using MBS item numbers 37203, 37207 and 36854, respectively. Using longitudinal MBS data, primary outcomes included need for revision surgery at 5-years follow-up (2015). The release of these data was approved by Medicare Australia upon application. Data analysis was conducted using chi-squared tests and statistical significance was defined at P < 0.05. The distribution of primary surgical procedures performed between 2005 and 2010 was: TURP 5579 (90%), TUIP 345 (6%) and PVP 258 (4%). TURP was also the most prevalent procedure for treatment of lower urinary tract symptoms in men with BPH requiring revision surgery (75%). At 5-year follow-up the rate of revision surgery for TURP (573/5579), TUIP (47/345) and PVP (30/258) was 10.3%, 13.6% and 11.6%, respectively. The difference was not statistically significant (P= 0.12). There was no significant change (P = 0.59) observed over the years in number of men requiring revision surgery. This study indicates that TURP and PVP have a similar durability after 5 years of follow-up.

Assessment and management of lower urinary tract symptoms in men.

Lower urinary tract symptoms (LUTS) is a broad term that covers a range of urinary issues, which are often categorised as storage and voiding symptoms. Storage symptoms include increased frequency, nocturia, urgency and urge incontinence, while voiding symptoms include hesitancy, suboptimal flow, dribbling and incomplete emptying. In men, the most common causes of LUTS are benign prostatic hyperplasia (prostate enlargement) and overactive bladder. This article provides an overview of the anatomy of the prostate and outlines the assessment process for men presenting with LUTS. It also explains the recommended lifestyle modifications, medicines and surgical interventions available to male patients who are experiencing these symptoms.

An overview of intermittent self-catheterisation.

British Journal of Community NursingVol. 28, No. 3 ProfessionalAn overview of intermittent self-catheterisationSarah Jane PalmerSarah Jane PalmerE-mail Address: [email protected]Registered nurse and freelance writer, based at the Department for Work and Pensions as a disability analystSearch for more papers by this authorSarah Jane PalmerPublished Online:28 Feb 2023https://doi.org/10.12968/bjcn.2023.28.3.128AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bladder and Bowel Community. Intermittent self catheterisation. 2022. https://www.bladderandbowel.org/conservative-treatment/intermittent-self-catheterisation/ (accessed 16 February 2023) Google ScholarHarding C, Mossop H, Homer T et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. https://doi.org/10.1136/bmj-2021-0068229 Medline, Google ScholarMarckiewicz A, Goldstine J, Nichols T. Emotional attributes, social connectivity and quality of life associated with intermittent catheterization. Int J Urol Nurs. 2020;14(1): 27-35. https://doi.org/10.1111/ijun.12222 Google ScholarNational Institute for Health and Care Excellence. Lower urinary tract symptoms in men: management. 2015. (accessed 16 February 2023) Google ScholarPickard R, Chadwick T, Oluboyede Y et al. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Health Technol Assess. 2018;22(24):1-102. https://doi.org/10.3310/hta22240 Crossref, Medline, Google ScholarRoyal College of Nursing. Catheter care. 2019. https://www.rcn.org.uk/-/media/Royal-College-Of-Nursing/Documents/Publications/2021/July/009-915.pdf (accessed 16 February 2023) Google ScholarShamout S, Biardeau X, Corcos J, Campeau L. Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 2017;55(7):629-643. https://doi.org/10.1038/sc.2016.192 Crossref, Medline, Google ScholarWellspect. Most common challenges. 2023. https://www.wellspect.co.uk/bladder/about-isc/most-common-challenges (accessed 16 February 2023) Google Scholar FiguresReferencesRelatedDetails 2 March 2023Volume 28Issue 3ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 28 February 2023 Published in print 2 March 2023 Information© MA Healthcare LimitedPDF download

Effects of long-term testosterone therapy on quality of life and lower urinary tract symptoms in men with functional hypogonadism

Effects of long-term testosterone therapy on quality of life and lower urinary tract symptoms in men with functional hypogonadism

Non-inferiority, randomized, open-label clinical trial on the efficacy of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia

Non-inferiority, randomized, open-label clinical trial on the efficacy of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia

A Comparative Analysis of Cystoscopy and Uroflowmetry in the Diagnostic Evaluation of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Prospective Study

A Comparative Analysis of Cystoscopy and Uroflowmetry in the Diagnostic Evaluation of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Prospective Study

Addressing Gender-Related Inequality in Continence Care

Addressing Gender-Related Inequality in Continence Care

Tadalafil vs Tamsulosin for the Management of Lower Urinary Tract Symptoms in Men with Benign Prostatic Hyperplasia: A Randomised Clinical Trial

Introduction: Tadalafil and tamsulosin have both been approved for use in the management of Lower Urinary Tract Symptoms (LUTS). Limited studies have shown the efficacy of tadalafil in terms of maximum urinary output flow (Qmax) and post-void residual (PVR). Aim: To compare the efficacy of tadalafil 5 mg and tamsulosin 0.4 mg in patients with Benign Prostatic Hyperplasia (BPH). Materials and Methods: A prospective, open-label, Randomised clinical study was conducted in the Department of Urology at Kurnool Medical College, Kurnool, Andhra Pradesh, India. The study duration was one year and five months, from February 2015 to July 2016. A total of 83 patients clinically diagnosed with BPH were included, but 23 patients were excluded from the analysis due to lost follow-up. The remaining 60 patients were randomly assigned to two groups: one receiving tadalafil 5 mg (n=30) and the other receiving tamsulosin 0.4 mg (n=30) for 12 weeks. Demographic characteristics, total International Prostate Symptom Score (IPSS), individual IPSS, Quality of Life (QoL) score, Qmax, PVR, and differences in symptoms were analysed. Data were analysed using the Wilcoxon signed-rank test and Mann-Whitney U test. A p-value&lt;0.05 was considered statistically significant. Results: The mean age for group I (tadalafil 5 mg) and Group II (tamsulosin 0.4 mg) was 62.7 and 61.0 years, respectively (p=0.147). Patients who received tadalafil showed significantly higher efficacy in all measures from baseline to 12 weeks, including increased Qmax (12.0 mL/sec vs 15.1 mL/sec), reduced QoL scores (4.2 vs 3.7), and PVR (26.5 mL vs 15.8 mL), compared to tamsulosin where the increase in Qmax was 11.6 mL/sec vs 13.6 mL/sec, reduction in QoL scores was 4.1 vs 2.4, and PVR was 24.0 mL vs 16.2 mL, between baseline and 12 weeks. Conclusion: Tadalafil 5 mg is a recent drug option available for the treatment of LUTS-BPH. The efficacy and safety of tadalafil 5 mg and tamsulosin 0.4 mg are comparable.

Techniques et intérêt clinique de la débitmétrie à domicile : une revue de la littérature

Urine flowmetry (UF) is a key non-invasive urodynamic test for the evaluation of the voiding phase in patients with lower urinary tract symptoms (LUTS). Traditional free urodynamic testing (FUT) performed on a one-time basis in the office is limited by difficulty in capturing normal voiding and high intrapatient variability in urine flow parameters. Home measurement of urine flow by the patient could be a way to obtain multiple data in real-life conditions, addressing its limitations. The objective of this article was to review the literature on the different techniques of home uroflowmetry (HUF) and their clinical interest in comparison with FUT. A search on the PubMed database using the key words "Urodynamics, Uroflowmetry, non-invasive urodynamics, Ambulatory urodynamics, bladder outlet obstruction, male LUTS" was performed to find articles in English or French that had been published with no time limit and March 2022. The sorting by reading the abstract allowed the selection of all articles describing and/or evaluating a HUF technique that were read entirely according to the same collection grid to propose a narrative synthesis. Thirty-one articles were identified, selected, and analyzed. Simple and inexpensive techniques by timing or use of funnels reliably and reproducibly estimate the average and maximum urine flow in relation to the FUT, without providing a complete flow curve. More sophisticated electronic or sonometric methods, some using connected mobile applications, present results that are more consistent with ICS recommendations for flow measurement. With the possibility of studying the average of several values of the maximum urinary flow (Qmax) captured during micturition in physiological conditions, some studies suggest a gain in diagnostic value in the evaluation of the emptying phase and lower urinary tract symptoms in men. However, the literature is sparse, old and the clinical benefits are not yet proven. There is a wide range of techniques for measuring urine flow in the patient's home, all of which aim to fill the gaps in conventional urine flow measurement. Further studies are needed to demonstrate the acceptability of this type of measurement by patients, the existence of a real clinical benefit, to assess the cost/benefit balance and finally to define a possible place for home uroflowmetry in daily practice, compared with traditional free flowmetry and invasive urodynamics (pressure-flow test).

Aquablation in men with benign prostate hyperplasia: A systematic review and meta-analysis.

The aim of the study is to investigate improvements in lower urinary tract symptoms in men with benign prostatic hyperplasia (BPH) treated with prostatic Aquablation. We performed a literature search of clinical trials using the MEDLINE, Embase, and Cochrane Library databases and retrieved published works on Aquablation for the treatment of BPH up to August 2021. Unpublished works, case reports, conference proceedings, editorial comments, and letters were excluded. Risk of bias was assessed using the ROBINS-I tool. Raw means and mean differences were meta-analyzed to produce summary estimates for pre- versus post-International Prostate Symptom Scores, maximum flow rate, and male sexual health questionnaire value changes. An inverse-variance weighted random effects model was used. Seven studies were included in this review (n = 551 patients) that evaluated various urological parameters. At 3 months, the International Prostate Symptom Scores raw mean difference from baseline was -16.475 (95% confidence interval [CI], -15.264 to -17.686; p < 0.001), with improvements sustained for 12 months. Similarly, maximum flow rate improved by +1.96 (95% CI, 10.015 to 11.878; p < 0.001) from pre to 3 months postoperatively. In addition, the male sexual health questionnaire change pooled effect size was -0.55 (95% CI, -1.621 to 0.531; p = 0.321) from preintervention to postintervention at 3 months. Meta-analyses of some outcomes showed large statistical heterogeneity or evidence of publication bias. Aquablation seems to improve lower urinary tract symptoms in men with BPH while providing relatively preserved sexual function. Further research is required to confirm these preliminary results.

Recent Updates in Surgical Treatment of Benign Prostatic Hyperplasia: A Review Article

Benign prostatic hyperplasia refers to the non-malignant growth or enlargement of the prostate gland and is a general cause of lower urinary tract symptoms in men which rises with growing age. There is a wide range of management options available from watchful waiting, and medicinal therapy to various surgical intervention methods. Though medicinal therapy is the preliminary treatment for benign prostatic hyperplasia, some patients lack the desire to keep on with the extended duration, and on occasion, they must break either due to treatment failure or side effects. Lately, numerous innovative surgical methodologies have been established to provide patients with efficient therapy on a day-care basis, without the risk of general anaesthesia and with rapid recovery, marginal morbidity, and safeguarding the reproductive function. Existing treatment alternatives for benign prostatic hyperplasia differ in the extent of intrusiveness, efficiency, complications, and cost-effectiveness. Various treatment modalities are available these days that are less invasive and have lesser complications as compared to conventional transurethral resection of the prostate. It helps curtail expenses, preserve time for recovery, curb untoward general and reproductive side effects. Laser, endoscopic, robotic, water vapor utilization, and various other minimally invasive methods have demonstrated their effectiveness in the treatment of benign prostatic hyperplasia in various studies.

Voiding Time for the Evaluation of Lower Urinary Tract Symptoms in Men – A Potential Option for Addressing Disparity Related Access to Urodynamic Testing

ObjectiveTo investigate voiding time (VT) in asymptomatic and symptomatic men, and compare VT to other parameters such as maximum flow rates (Qmax) as a possible solution to disparity related lack of access to standard urodynamic testing. MethodsWe conducted a controlled prospective study on a total of 30 patients. Exclusion criteria included ongoing medical therapy for lower urinary tract symptoms (LUTS) or a history of invasive therapy for LUTS. Patients completed International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry, and post-void residual (PVR) testing. Symptomatic LUTS was defined as an IPSS ≥8. ResultsOn univariate analysis, men with a symptomatic LUTS had a significantly longer VT than asymptomatic men (30.6 seconds (Interquartile rage [IQR] 24.2-42.4) vs 20.5 seconds (IQR 16.6-40.5), P = .04). VT was not otherwise associated with age, race, or primary complaint. There was trend towards lower Qmax in symptomatic patients (13.4 vs 20.5 seconds, P = .07), although this was not statistically significant. Our study demonstrated that the sensitivity of a VT ≥23.5 seconds, or probability of observing a VT exceeding 23.5 seconds when the patient has a symptomatic IPSS, is 85%. On sensitivity and specificity analysis, there was no difference between the abilities of VT and Qmax to predict that a patient would have symptomatic LUTS (P = .80). ConclusionIn this controlled prospective study, we found that VT was as accurate as Qmax in predicting symptomatic IPSS scores. This novel finding might improve the ability to diagnose and treat LUTS, especially in primary care offices and underserved areas.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia.

A variety of minimally invasive surgical approaches are available as an alternative to transurethral resection of the prostate (TURP) for management of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Prostatic arterial embolization (PAE) is a relatively new, minimally invasive treatment approach. To assess the effects of PAE compared to other procedures for treatment of LUTS in men with BPH. We performed a comprehensive search the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of grey literature, and conference proceedings with no restrictions on language of publication or publication status, up to 8 November 2021. We included parallel-group randomized controlled trials (RCTs), as well as non-randomized studies (NRS, limited to prospective cohort studies with concurrent comparison groups) enrolling men over the age of 40 years with LUTSattributed to BPH undergoing PAE versusTURP or other surgical interventions. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies for inclusion or exclusion and abstracted data from the included studies. We performed statistical analyses by using a random-effects model and interpreted them according to the Cochrane Handbook for Systematic Reviews of Interventions. We used GRADE guidanceto rate the certainty of evidence of RCTs and NRSs. MAIN RESULTS: We found data to inform two comparisons: PAE versus TURP (six RCTs and two NRSs), and PAE versus sham (one RCT).Mean age was 66 years, International Prostate Symptom Score (IPSS) was 22.8, and prostate volume of participants was 72.8 mL. This abstract focuses on the comparison of PAE versus TURP as the primary topic of interest. Prostatic arterial embolization versus transurethral resection of the prostate We included sixRCTs and two NRSs with short-term (up to 12 months) follow-up, and two RCTs and one NRS with long-term follow-up (13 to 24 months). Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement measured by the International Prostatic Symptom Score (IPSS) on a scale from 0 to 35, with higher scores indicating worse symptoms (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; 6 RCTs, 360 participants; I² = 78%; low-certainty evidence). There may be little to no difference in quality of life as measured by the IPSS-quality of life question on a scale from 0 to 6, with higher scores indicating worse quality of life between PAE and TURP, respectively (MD 0.28, 95% CI -0.28 to 0.84; 5 RCTs, 300 participants; I² = 63%; low-certainty evidence). While we are very uncertain about the effects of PAE on major adverse events (risk ratio [RR] 0.75, 95% CI 0.19 to 2.97; 4 RCTs, 250 participants; I² = 24%; very low-certainty evidence), PAE likely increases retreatments (RR 3.20, 95% CI 1.41 to 7.27; 4 RCTs, 303 participants; I² = 0%; moderate-certainty evidence). PAE may make little to no difference in erectile function measured by the International Index of Erectile Function-5 on a scale from 1 to 25, with higher scores indicating better function (MD -0.50 points, 95% CI -5.88 to 4.88; 2 RCTs, 120 participants; I²= 68%; low-certainty evidence). Based on NRS evidence, PAE may reduce the occurrence of ejaculatory disorders (RR 0.51, 95% CI 0.35 to 0.73; 1 NRS, 260 participants; low-certainty evidence). Long-term follow-up:based on RCT evidence, PAE may result in little to no difference in urologic symptom scores (MD 2.58 points, 95% CI -1.54 to 6.71; 2 RCTs, 176 participants; I² = 73%; low-certainty evidence) and quality of life (MD 0.50 points, 95% CI -0.03 to 1.04; 2 RCTs, 176 participants; I² = 29%; low-certainty evidence). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20 to 4.05; 2 RCTs, 206 participants; I² = 72%; very low-certainty evidence). PAE likely increases retreatments (RR 3.80, 95% CI 1.32 to 10.93; 1 RCT, 81 participants; moderate-certainty evidence). While PAE may result in little to no difference in erectile function (MD 3.09 points, 95% CI -0.76 to 6.94; 1 RCT, 81 participants; low-certainty evidence), PAE may reduce the occurrence of ejaculatory disorders (RR 0.67, 95% CI 0.45 to 0.98; 1 RCT, 50 participants; low-certainty evidence). Compared to TURP, PAE may provide similar improvement inurologic symptom scores and quality of life. While we are very uncertain about major adverse events, PAE likely increases retreatment rates. While erectile function may be similar, PAE may reduce ejaculatory disorders. Certainty of evidence for the outcomes of this review was low or very low except for retreatment (moderate-certainty evidence), signaling that our confidence in the reported effect size is limited or very limited, and that this topic should be better informed by future research.