Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia.
OBJECTIVE
To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO).


METHODS
A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE.


RESULTS
Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3 months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21 ml/s to +9.5 ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3 months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24 months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10 % of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures.


CONCLUSIONS
Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.
Service d'Urologie, Centre Hospitalier Universitaire d'Angers, 4, rue Larrey, 49933, Angers Cedex 9, France. souhil.lebdai@gmail.com.
Souhil
S
Lebdai
Urology Department, University Hospital of Cochin, 75014, Paris, France.
Nicolas Barry
NB
Delongchamps
Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France.
Marc
M
Sapoval
Urology Department, University Hospital of Bordeaux, Bordeaux, France.
Grégoire
G
Robert
Interventional Radiology Department, Hôpital Européen Georges Pompidou, Paris, France.
Gregory
G
Amouyal
Urology Department, Hôpital Européen Georges Pompidou, Paris, France.
Nicolas
N
Thiounn
Urology Department, University Hospital of Marseilles, Marseilles, France.
Gilles
G
Karsenty
Urology Department, University Hospital of Lyon, Lyon, France.
Alain
A
Ruffion
Urology Department, University Hospital of Mondor, Paris, France.
Alexandre
A
de La Taille
Urology Department, University Hospital of Limoges, Limoges, France.
Aurélien
A
Descazeaud
Urology Department, University Hospital of Rennes, 35000, Rennes, France.
Romain
R
Mathieu
D001158:Arteries; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000209:etiology / Q000628:therapy*; D008297:Male; D011467:Prostate / Q000098:blood supply*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
Benign prostatic hyperplasia; Low urinary tract symptoms; Prostatic arterial embolization