Abstract
Purpose
To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia.
Methods
We prospectively randomized 30 patients to receive TURP or original PAE (oPAE) and compared them to a cohort of patients treated by PErFecTED PAE, with a minimum of 1-year follow-up. Patients were assessed for urodynamic parameters, prostate volume, international prostate symptom score (IPSS), and quality of life (QoL).
Results
All groups were comparable for all pre-treatment parameters except bladder contractility and peak urine flow rate (Q max), both of which were significantly better in the TURP group, and IIEF score, which was significantly higher among PErFecTED PAE patients than TURP patients. All groups experienced significant improvement in IPSS, QoL, prostate volume, and Q max. TURP and PErFecTED PAE both resulted in significantly lower IPSS than oPAE but were not significantly different from one another. TURP resulted in significantly higher Q max and significantly smaller prostate volume than either original or PErFecTED PAE but required spinal anesthesia and hospitalization. Two patients in the oPAE group with hypocontractile bladders experienced recurrence of symptoms and were treated with TURP. In the TURP group, urinary incontinence occurred in 4/15 patients (26.7 %), rupture of the prostatic capsule in 1/15 (6.7 %), retrograde ejaculation in all patients (100 %), and one patient was readmitted for temporary bladder irrigation due to hematuria.
Conclusions
TURP and PAE are both safe and effective treatments. TURP and PErFecTED PAE yield similar symptom improvement, but TURP is associated with both better urodynamic results and more adverse events.
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Abbreviations
- BPH:
-
Benign prostatic hyperplasia
- BCI:
-
Bladder contractility index
- BOO:
-
Bladder outlet obstruction
- BOOI:
-
Bladder outlet obstruction index
- CT:
-
Computed tomography
- P det :
-
Detrusor muscle pressure
- DRE:
-
Digital rectal examination
- DSA:
-
Digital subtraction angiography
- ED:
-
Erectile dysfunction
- IVA:
-
Inferior vesical artery
- IVO:
-
Infravesical obstruction
- IRB:
-
Institutional review board
- IIEF-5:
-
International index of erectile function
- IPSS:
-
International prostate symptom score
- LUTS:
-
Lower urinary tract symptoms
- MRI:
-
Magnetic resonance imaging
- Q max :
-
Maximum urinary flow rate
- oPAE:
-
Original PAE method
- PVR:
-
Post-void residual urine volume
- PAE:
-
Prostate artery embolization
- PSA:
-
Prostate specific antigen
- PErFecTED:
-
Proximal embolization first then embolize distal method of PAE
- QoL:
-
Quality of life
- TRUS:
-
Transrectal ultrasound
- TURP:
-
Transurethral resection of the prostate
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Acknowledgments
The authors thank Vanessa Cristina de Paula Rodrigues, Sardis Honoria Harward, and Andre Moreira de Assis for their important collaboration.
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Carnevale, F.C., Iscaife, A., Yoshinaga, E.M. et al. Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis. Cardiovasc Intervent Radiol 39, 44–52 (2016). https://doi.org/10.1007/s00270-015-1202-4
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DOI: https://doi.org/10.1007/s00270-015-1202-4