To assess and compare the clinical efficacy and safety of prostatic urethral lift (PUL) and prostatic artery 2mbolization (PAE) for the treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH) by means of a systematic review and network meta-analysis.
Systematic literature retrieval was performed by searching data in PudMed and Web of Science from inception to March 2021 to identify randomised controlled trials (RCT) that compared PUL or PAE with either transurethral resection of the prostate (TURP) or sham procedures as control interventions. The quality and quantitative analyses were performed to pool the data of direct and indirect comparison between interventions using STATA 14.
Eight RCTs with 675 participants were included for network meta-analysis. Quantitative synthesis revealed that TURP was the most efficacious intervention for clinical (IPSS and QoL) and functional outcomes (Qmax and PVR), with fewer reintervention rate compared with PAE (RR 2.08 with 95% CI 0.96 to 4.51) and PUL (RR 2.33 with 95% CI 0.50 to 10.86), although without significant difference. Indirect comparison indicated that PUL and PAE resulted in similar outcomes. Furthermore, PAE was associated with fewer minor adverse events (AE) (RR 0.75 with 95% CI 0.48 to 1.18), and PUL with fewer major Aes (RR 0.72 with 95% CI 0.17 to 3.13) when compared with TURP. Whilst PAE showed better ranking in improvement of most clinical and functional outcomes, PUL was the best rank procedure regarding the erectile function measured by IIEF-5, but no significant difference was observed.
Current evidence suggests that PUL and PAE have the comparable profiles regarding clinical efficacy and safety in the management of LUTS associated with BPH. However, quality of evidence is relatively low due to the paucity of RCTs available, and the interpretation of results should be made with caution.
BJU international. 2022 Apr 13 [Epub ahead of print]
Vanesa Lucas-Cava, Francisco Miguel Sánchez-Margallo, Iñigo Insausti-Gorbea, Fei Sun
Endoluminal Therapy and Diagnosis Unit. Jesús Usón Minimally Invasive Surgery Centre. Cáceres, Spain., Scientific Director. Jesús Usón Minimally Invasive Surgery Centre. Cáceres, Spain., Department of Interventional Radiology, Complejo Hospitalario de Navarra, Pamplona, Spain.