Prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: A systematic review and meta-analysis

Table 1 The main characteristic and quality assessment of eligible studies

Studies	Study design	Country	Sample size		Inclusion criteria	Interventions		Follow-up (mo)	Outcome measuresa	Quality assessmentb
			PAE	TURP		PAE	TURP
Abt 2021	Prospective study	Switzer--land	48	51	Age ≥ 40 yr; PV 25-80 mL; IPSS ≥ 8; QoL ≥ 3; Qmax ≤ 12 mL/s	Bilateral (36); unilateral (12); 250-400 µm microspheres	Monopolar	3, 6, 12, 24	1, 2, 3, 4, 5, 6, 7, 8, 9	19
Carnevale 2016	Prospective study	Brazil	15	15	Age ≥ 45yr; PV 30-90 mL; IPSS ≥ 19	Bilateral (13); unilateral (2); 300-500µm microspheres	Monopolar	12	1, 2, 3, 4, 5, 6, 7, 8	21
Gao 2014	Prospective study	China	54	53	PV 20-100 mL; IPSS > 7; Qmax ≤ 15 mL/s	Bilateral (48); unilateral (6); 355-500 µm polyvinyl alcohol microspheres	Bipolar	1, 3, 6, 12, 24	1, 2, 3, 4, 5, 6, 8, 9	21
Gu 2018	Prospective study	China	50	50	Age > 55 yr; PV 70-150 mL; IPSS ≥ 25; QoL ≥ 5	Bilateral or unilateral; BioSphere Medical S.A 100-300 µm	Bipolar	6	1, 2, 3, 4, 5	19
Hou 2016	Retrospective study	China	31	39	Age ≥ 49 yr; PV 60-110 mL; IPSS > 7; QoL > 3; Qmax < 12 mL/s	Bilateral; polyvinyl alcohol microspheres	Bipolar	3, 6, 12, 24	1, 2, 3, 4, 5	17
Insausti 2020	Prospective study	Spain	23	22	Age > 60yr; IPSS > 19; QoL > 3; Qmax ≤ 10 mL/s	Bilateral; 300-500 µm polyvinyl alcohol microspheres	Bipolar	3, 6, 12	1, 2, 3, 4, 5, 6, 8, 9	21
Qiu 2017	Retrospective study	China	17	40	Age > 60 yr; PV > 50mL; IPSS > 7; QoL > 3; Qmax < 13 mL/s	Bilateral or unilateral; 90-180 µm embosphere microspheres	Bipolar	3, 6, 12	1, 2, 3, 5	17
Ray 2018	Prospective study	British	216	89	Age > 60 yr; PV > 50mL; IPSS > 7; QoL > 3; Qmax < 15 mL/s	Bilateral; polyvinyl alcohol microspheres	Monopolar (45) Bipolar (44)	1, 3, 6, 12	1, 2, 3, 4, 5, 7	19
Tan 2018	Prospective study	China	47	47	Age ≥ 50 yr; PV > 60 mL; IPSS > 19; QoL > 4; Qmax < 13 mL/s	Bilateral; polyvinyl alcohol microspheres	Bipolar	3, 6, 12	1, 2, 3, 4, 5, 6, 9	21
Wang 2018	Prospective study	China	61	62	Age > 55 yr; PV > 45 mL; IPSS > 19; QoL > 3; Qmax < 10 mL/s	Bilateral; polyvinyl alcohol microspheres	Bipolar	3	1, 2, 3, 4, 7, 8, 9	20
Zhu 2018	Prospective study	China	20	20	Age ≥ 49 yr; PV>60mL; IPSS>7; QoL>3; Qmax < 12 mL/s	Bilateral; 100–300 or 310–500µm Microspheres	Bipolar	3, 6, 12	1, 2, 3, 4, 5, 6	19

^aOutcome measures: 1. IPSS; 2. QoL; 3. Qmax; 4. PVR; 5. PV; 6. PSA; 7. IIEF; 8. Procedure time; 9. Hospital stay.

^bQuality assessment is based on the methodological index for nonrandomized studies.

BPH: Benign prostatic hyperplasia; IIEF-5: International index of erectile function; IPSS: International prostate symptom score; LUTS: Lower urinary tract symptoms; PAE: Prostate artery embolization; PSA: Prostate-specific antigen; PV: Prostate volume; PVR, Postvoid residual; Qmax: Peak urinary flow rate; QoL: Quality of life; TURP: Transurethral resection of the prostate.

Table 2 Complications reported in the eligible studies

Complications	Haematuria	Irritation or pain	Urinary retention	Urinary incontinence	Urinary tract infection	Urinary stricture	Major events (clavien ≥ 3)	Total
PAE	46 (8.14%)	222 (39.29%)	27 (4.78%)	2 (0.35%)	30 (5.31%)	1 (0.18%)	12 (2.12%)	349 (61.77%)
TURP	88 (19.64%)	149 (33.26%)	15 (3.35%)	18 (4.02%)	35 (7.81%)	14 (3.13%)	15 (3.35%)	362 (80.8%)
P value	< 0.00001	0.05	0.26	0.001	0.11	0.005	0.23	< 0.00001

PAE: Prostate artery embolization; TURP: Transurethral resection of the prostate.