April 2, 2020
PAE Compared to Transurethral Resection to Treat LUTS Secondary to Benign BPH
April 2, 2020—Iñigo Insausti, MD, et al conducted a noninferiority randomized trial comparing the clinical and functional outcomes of prostatic artery embolization (PAE) versus transurethral resection of the prostate (TURP) for treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The findings were published online ahead of print in Journal of Vascular and Interventional Radiology (JVIR).
As summarized in JVIR, the study was composed of 45 men, aged > 60 years, with LUTS secondary to BPH. From November 2014 to January 2017, patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300–500-μm microspheres with the patient under local anesthesia. Bipolar TURP was performed with the patients under spinal or general anesthesia.
Primary outcomes were changes in peak urinary flow (Qmax) and changes in international prostate symptoms score (IPSS) from baseline to 12 months. Secondary outcomes were quality of life (QoL) and prostate volume (PV) changes from baseline to 12 months. Adverse events were compared using the Clavien classification.
The investigators concluded that the reduction of LUTS in the PAE group was similar to that in the TURP group, with fewer complications secondary to PAE. They reported the following changes at 12 months for PAE versus TURP patients:
- Mean Qmax increase was 6.1 mL/s versus 9.6 mL/s (P = .862 for noninferiority)
- Mean IPSS reduction was 21 points versus 18.2 points (P = .08)
- QoL improvement was 3.78 points versus 3.09 points (P = .002)
- Mean PV reduction was 20.5 cm³ versus 44.7 cm³ (34.2% vs 71.2%); P < .001)
- Number of adverse events was 15 versus 47 (P < .001)
Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure, advised the investigators in JVIR.