Prostatic arterial embolization for men with benign prostatic hyperplasia: Cochrane review

Objectives
To assess the effects of prostatic arterial embolization (PAE) compared to other procedures for treatment of lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH).

Methods
We included randomized controlled trials (RCTs), as well as non-randomized studies (NRSs) enrolling men with BPH undergoing PAE versus other surgical interventions via a comprehensive search up until 8 Nov 2021. Two independent reviewers screened the literature, extracted data, assessed risk of bias, performed statistical analyses by using a random-effects model, and rated the certainty of evidence (CoE) of RCTs and NRSs.

Results
We found data to inform two comparisons: PAE versus transurethral resection of prostate (TURP, six RCTs and two NRSs), and PAE versus sham (one RCT). This abstract focuses on the primary outcomes in a comparison of PAE versus TURP.

Short-term follow-up: based on RCT evidence, there may be little to no difference in urologic symptom score improvement (mean difference [MD] 1.72, 95% confidence interval [CI] -0.37 to 3.81; low CoE) and quality of life (MD 0.28, 95% CI -0.28 to 0.84; low CoE) measured by International Prostatic Symptom Score. 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; very low CoE).

Long-term follow-up: based on RCT evidence, PAE may result in little to no difference in urologic symptom scores (MD 2.58, 95% CI -1.54 to 6.71; low CoE) and quality of life (MD 0.50, 95% CI -0.03 to 1.04; low CoE). We are very uncertain about major adverse events (RR 0.91, 95% CI 0.20 to 4.05; very low CoE).

Conclusion
Compared to TURP, the impact on urologic symptoms and quality of life improvement as perceived by patients appears to be similar. This review did reveal major uncertainty as to how major adverse events compare.