Minimally Invasive Surgery for Benign Prostatic Obstruction

New Insights and Future Technical Standards

Enrique Rijo; Richard Hindley; Shahin Tabatabaei; Thorsten Bach

Disclosures

Curr Opin Urol. 2021;31(5):461-467. 

In This Article

Prostatic Artery Embolization

Prostatic artery embolization (PAE) has been considered a safe and efficient procedure for selected cases, however, it is technically complex and requires the participation of a multidisciplinary team of urologists and experienced interventional radiologists.

This procedure is mostly indicated for patients who refuse surgery or are unfit for surgery/anesthesia due to important comorbidities.

PAE can usually be done as outpatient procedure under local anesthesia without having to stop anticoagulant treatments.[13]

A recent single-center randomized trial including 103 patients compared the efficacy and safety of PAE and TURP with 24 months of follow-up and reported lower mean reduction in IPSS in the PAE group vs TURP group (9.21 vs 12.09).

Qmax improvement was 3.9 mL/s and 10.23 mL/s in the PAE and TURP group, respectively.[14]

PVR reduction was significantly less in the PAE than TURP arm (62.1 vs 204 mL).

Prostate volume reduction was 10.66 vs 30.20 mL in PAE and TURP groups, respectively.

Complications were less frequent after PAE than after TURP. The anejaculation was 16% vs 52% in PAE and TURP, respectively.

The reported surgical retreatment rate after PAE was 21% at 2 years.[14]

The latest evidence demonstrates that PAE compared with TURP offers inferior functional outcomes and should only be offered in centers with experienced interventional radiologists to very select patients who are willing to accept a high surgical retreatment rate.[14]

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