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.
OBJECTIVE
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.
Interventional Radiology Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. fcarnevale@uol.com.br.|, Rua Teodoro Sampaio, 352, cj.17, Sao Paulo, 05406-000, Brazil. fcarnevale@uol.com.br.
Francisco C
FC
Carnevale
Division of Urology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. iscaifeboni@yahoo.com.br.
Alexandre
A
Iscaife
Division of Urology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. dumuracca@ig.com.br.
Eduardo M
EM
Yoshinaga
Interventional Radiology Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. motamoreira@gmail.com.
Airton Mota
AM
Moreira
Division of Urology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. antunesuro@uol.com.br.
Alberto A
AA
Antunes
Division of Urology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil. srougi@uol.com.br.
Miguel
M
Srougi
D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000150:complications / Q000628:therapy*; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014563:Urodynamics
Embolization/embolisation/embolotherapy; Prostate; Therapy; Urinary tract