Meta-analysis of the efficacy of prostate artery embolization in prostatic hyperplasia

Objective: The purpose of this article was to assess the efficacy of PAE in the treatment of LUTS related to BPH. Methods: Databases including PubMed, MEDLINE, EMBASE, the Cochrane Library, and other related sources were searched, with the results limited to items published between Jan. 1st, 2000 and Jun. 30th, 2017, for randomized controlled studies concerning PAE/BPH/LUTS and with no language restriction. Eligible randomized controlled trials (RCTs) were selected by independent paired researchers according to the inclusion and exclusion criteria. The overall quality of each of the included RCTs was assessed using the Cochrane risk of bias tool. The main outcome measures included the quality of life score (QoL), prostate volume (PV), the international prostate symptom score (IPSS), the maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR volume), prostate-specific antigen (PSA), and the international index of erectile function (IIEF-5). The fixed effect model or random effect model was selected for the meta-analysis using RevMan 5.2 software. Results: Nine RCTs containing 508 patients were included. Compared with the baseline, the meta-analysis for this study showed that the QoL scores were significantly lowered after PAE at postoperative 1, 3, and 12 months (all P<0.001). The PV showed no significant change after PAE at postoperative 1 and 3 months (P=0.39, P=0.49), but it decreased significantly at postoperative 12 months (P<0.00001). Significant improvements were shown in IPSS (all P<0.00001) and Qmax (all P<0.0001) after PAE at postoperative 1, 3, and 12 months. The PVR volume was significantly improved after PAE at postoperative 1, 3, and 12 months (P=0.009, P=0.010, P=0.004). The PSA presented no improvement after PAE at postoperative 1 and 12 months (P=0.73, P=0.37), but it presented significant improvement after 3 months (P<0.0001). IIEF-5 showed no improvement after PAE at postoperative 1, 3, and 12 months (P=0.46, P=1.00, P=0.67). Conclusion: PAE is an effective treatment for BPH-induced LUTS.