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Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study

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A Letter to the Editor to this article was published on 11 February 2023

Abstract

Background

There are growing interests for minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Prostatic artery embolization (PAE) uses selective angioembolization of prostatic arteries, thereby reducing size to improve LUTS/BPH. However, real-world data comparing surgical outcomes between MISTs and tissue resective techniques are lacking. We assessed the differences in surgical outcomes between PAE, transurethral resection of the prostate (TURP), and prostatic urethral lift (PUL) in a real-world population for LUTS/BPH.

Methods

We present an observational population-based study of 12,902 men with BPH in New York State who received PAE, TURP, and PUL in outpatient and ambulatory surgery settings from 2014 to 2018. For short-term outcomes, we report 30-day and 90-day risks of readmission to inpatient and emergency room (ER) with/without complications and compared them across groups using χ2 tests and mixed-effect logistic regressions. For long-term outcomes, we report surgical retreatment and stricture rates using Kaplan–Meier failure curves and compared them using Log rank tests and Cox regression models.

Results

Of 12 902 men, 335 had PAE, 11,205 had TURP, and 1362 had PUL. PAE patients had the highest 30-day (19.9%) and 90-day (35.6%) risks of readmission to inpatient or ER (p < 0.01). Non-specific abdominal pain was the main diagnosis associated with 30-day and 90-day readmissions to inpatient or ER after PAE (14.3% and 26.8%, respectively). After 2 years of follow-up, PAE patients had the highest retreatment rate of 28.5% (95%CI 23.7–34.2%) compared to TURP (3.4% (95%CI 3.1–3.8%)) and PUL (8.5% (95%CI 5.6–12.9%)) (p < 0.001).

Conclusion

In a real-world population, PAE was associated with the most frequent 30-day and 90-day readmission to inpatient or ER and the highest retreatment rate among all surgical techniques even when controlled for individual patient comorbidities and surgical volume.

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Acknowledgements

The data used to produce this publication were provided by the New York State Department of Health (NYSDOH). However, the conclusions derived, and views expressed therein are those of the author(s) and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty, or guarantee as to the accuracy, completeness, currency, or suitability of the information provided here.

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Authors and Affiliations

  1. Division of Urology, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Brendan L. Raizenne, Kevin C. Zorn & Naeem Bhojani

  2. Department of Population Health Sciences, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA

    Xinyan Zheng, Jialin Mao, Art Sedrakyan & Bilal Chughtai

  3. Faculty of Medicine, Université de Montréal, Montreal, QC, Canada

    Kussil Oumedjbeur

  4. Division of Urology, University Health Network, University of Toronto, Toronto, ON, Canada

    Dean Elterman

  5. Department of Urology, Weill Cornell Medical College/New York Presbyterian, 425 East 61St St., 12th Floor, New York, NY, 10065, USA

    Timothy McClure, Alexis Te & Bilal Chughtai

  6. Department of Urology, Mount Sinai Hospital, New York, NY, USA

    Steven Kaplan

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  1. Brendan L. Raizenne
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Contributions

BLR: project development, data collection, manuscript writing. XZ: data collection, data analysis, manuscript writing. KO: manuscript writing. JM: data collection, data analysis, manuscript editing. KCZ: manuscript editing. DE: manuscript editing. NB: manuscript editing. TM: manuscript editing. AT: manuscript editing. SK: manuscript editing. AS: project development. BC: project development, manuscript editing.

Corresponding author

Correspondence to Bilal Chughtai.

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Conflict of interest

NB is a consultant and investigator for Boston Scientific, Olympus, and PROCEPT BioRobotics. BC is a consultant and investigator for Boston Scientific and Olympus. KCZ is a consultant for Boston Scientific, and PROCEPT BioRobotics. DE is a consultant and investigator for PROCEPT BioRobotics. All other authors report no relevant conflicts of interest.

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Raizenne, B.L., Zheng, X., Oumedjbeur, K. et al. Prostatic artery embolization compared to transurethral resection of the prostate and prostatic urethral lift: a real-world population-based study. World J Urol 41, 179–188 (2023). https://doi.org/10.1007/s00345-022-04218-6

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