Comparing prostatic artery embolization to transurethral resection of the prostate in patients with benign prostatic hyperplasia.

This study compared the effectiveness and safety of prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms (LUTS) from benign prostatic obstruction (BPO). The data showed fewer complications but lower effectiveness in improving LUTS with PAE compared to TURP.

LUTS include urinary symptoms such as an inability to pass urine, a weak urine stream, and prolonged urination. They are commonly caused by BPO. BPO is the growth of prostate tissue that blocks the urine flow out of the bladder, through the urethra (tube that passes urine).

A standard treatment for BPO is TURP. TURP involves the surgical removal of parts of the prostate through the penis. However, TURP is associated with more complications compared to minimally invasive treatments (MIT) such as laser removal of prostate tissue. PAE is another MIT that involves blocking blood flow to the blood vessels supplying blood to the prostate. This procedure is done through a small puncture in the groin. By blocking blood flow, some parts of the prostate die resulting in lower pressure on the urethra. The safety and effectiveness of PAE compared to TURP are still not clear.

The study included 81 men with refractory LUTS from BPO. 34 patients were randomly assigned to receive PAE. 47 patients received TURP. Patients were followed up for 2 years. 

There was a significantly higher improvement in urinary symptoms and quality of life in patients treated with TURP compared to those who received PAE after 2 years. PAE was also less effective than TURP for improving urinary flow rate and for reducing the residual urine volume after urination and prostate volume. 

Overall, significantly fewer side effects were reported with PAE compared to TURP after 3 months. These differences were not significant at 2 years. Significantly more patients in the TURP group reported ejaculation problems (84%) compared to PAE (56%). 21% of patients that received PAE required TURP after 2 years.

The study showed that PAE was associated with fewer side effects, but lower effectiveness in improving LUTS compared to TURP in patients with BPO. 

Patient numbers were low in the study after 24 months and a larger follow-up group is desirable.