An Meta-analysis Of Interventional Embolization Versus Transurethral Resection Of The Prostate In The Treatment Of Benign Prostatic Hyperplasia

Objective:In order to investigate whether prostate arterial embolization(PAE)can be recommended as an alternative treatment for benign prostatic hyperplasia(BPH),this study evaluated the efficacy and safety of prostate arterial embolization(PAE)and transurethral resection of the prostate(TURP)in the treatment of benign prostatic hyperplasia(BPH)with Meta analysis.Methods:By systematically searching the databases of Pubmed,Embase,Cochrane,CNKI,Wanfang and Sinomed,etc.,the PAE and TURP comparative treatment of BPH that meet the inclusion criteria will be screened out for quality evaluation and data extraction.Finally,using RevMan5.3 software for meta-analysis.Results:Eighteen studies comparing PAE and TURP were included,including 6 randomized control groups and 12 non-randomized control groups,for a total of 1733 BPH patients.Clinical effect: There was no significant difference in the IPSS between the two groups at 3 months,6 months,and 24 months after surgery(P> 0.5),while the IPSS of the TURP group was better than that of the PAE group at 12 months after surgery(P<0.5).There was no significant difference in QOL between the two groups at 3 months,6 months,12 months,and 24 months(P> 0.5).There was no statistically significant difference in PV between the two groups at 3 and 24 months after surgery(P> 0.5),while PV at 6 and 12 months after surgery decreased in the TURP group compared with the PAE group(P <0.5)).There was no significant difference in PVR between the two groups at 3 months,6 months,12 months,and 24 months(P> 0.5).There were no significant differences in Qmax between the two groups at 3 months,6 months,12 months,and 24 months(P> 0.5).There was no significant difference in PSA between the two groups at 6 and 12 months postoperatively(P> 0.5),while the PSA of the TURP group was lower than that of the PAE group at 3 months postoperatively(P <0.5).There was no significant difference in IIEF-5 between the two groups at 3 and 12 months after surgery(P> 0.5).Safety: Compared with TURP group,PAE group had advantages in less postoperative bleeding [SMD =-4.28,95% CI(-7.34,-1.21),P = 0.006]?shorter postoperative indwelling catheterization time [SMD =-1.41,95% CI(-2.67,0.14),P = 0.03] ?short hospitalization time [SMD =-0.82,95% CI(-2.19,0.55),P = 0.24]?low incidence of sexual dysfunction [OR = 0.24,95% CI(0.15,0.39),P <0.00001]?and lower incidence of postoperative complications [OR = 0.48,95% CI(0.27,0.85),P = 0.01],while the operation time was no significant difference between PAE group and TURP group [SMD =-0.82,95% CI(-2.19,0.55),P = 0.24].Conclusion:1.In the treatment of BPH,the short-term,mid-term and long-term follow-up of PAE have no significant difference with TURP.2.Compared with TURP,PAE has a better safety.PAE has advantages in less postoperative bleeding?shorter postoperative indwelling catheterization time?shorter hospitalization time? lower incidence of sexual dysfunction and lower incidence of postoperative complications.3.TURP is still the gold standard for treating BPH patients,but for patients who refuse surgery or surgical contraindications,PAE has the potential to be an effective alternative to TURP in terms of safety and efficacy.4.Due to the problems of small sample size?single centers?few RCTs?short follow-up time and inconsistent inclusion criteria,more multicenter,large samples,and long-term follow-up RCTs will be needed in the future to further verify whether PAE can be used as a conventional means of BPH.