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Randomized Controlled Trial Comparing Open Simple Prostatectomy or Prostate Artery Embolization in Large Prostates:

Bruno Rodrigues Lebani1, Daniel Dias de Souza Porto2, André Barcelos da Silva1

  • 1Department of Surgery, Division of Urology, Voiding Dysfunction Section, São Paulo Hospital - Federal University of São Paulo, São Paulo, Brazil.

Urology
|May 2, 2024
PubMed
Summary

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Prostate artery embolization (PAE) showed less effectiveness than open simple prostatectomy (OP) in improving urinary flow and relieving obstruction for large prostates. However, PAE offers symptom relief and may suit selected patients.

Area of Science:

  • Urology
  • Interventional Radiology
  • Surgical Innovation

Background:

  • Large prostates (>80cc³) often cause lower urinary tract symptoms and bladder outlet obstruction (BOO).
  • Treatment options include medication, minimally invasive procedures, and traditional surgery.
  • Prostate artery embolization (PAE) is a newer option, but its efficacy compared to surgery for large prostates needs further evaluation.

Purpose of the Study:

  • To compare the effects of PAE and open simple prostatectomy (OP) on lower urinary tract symptoms and urodynamic parameters.
  • To assess the impact on peak urinary flow rate (Qmax) and Bladder Outlet Obstruction Index (BOOI) in men with large prostates.

Main Methods:

  • A randomized controlled trial (PoPAE study) included men with prostates >80cc³, BOOI >40, and good detrusor function.

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  • Primary endpoints were changes in Qmax and BOOI after 6 months.
  • Secondary endpoints included International Prostate Symptom Score (IPSS) and ultrasonographic changes.

    • Main Results:

    • Open simple prostatectomy (OP) led to a significantly greater improvement in Qmax compared to PAE.
    • After 6 months, 88% of OP patients were unobstructed, while 70% of PAE patients remained obstructed.
    • Both PAE and OP showed similar improvements in IPSS and post-void residual (PVR) volume.

    Conclusions:

    • PAE is less effective than OP in relieving BOO and improving peak urinary flow in men with large prostates.
    • PAE demonstrated efficacy in improving lower urinary tract symptoms and PVR.
    • PAE may serve as a viable alternative treatment for carefully selected patients with large prostates.